Free Emergency Medicine CME

Activity Description / Statement of Need:

In this online, self-learning activity: Goal-directed therapy (GDT) has been taken as the gospel in critical care since the publication of Rivers et al.’s seminal paper on the topic demonstrating a mortality benefit in patients with severe sepsis and related shock in late 2001. Its protocols were soon embraced and became ensconced in practice as standards of care, overlapping with other, high-acuity areas of medical specialty like surgery and emergency medicine. One challenge has been the conventional approach’s embrace a ‘recipe-book’ or one-size-fits all approach with directed by static parameters. The literature clearly demonstrates that indiscriminate administration of fluids is associated with a number of complications, increased length of stay, and mortality in a diverse array of patient populations, findings all the more important because only half of hemodynamically unstable patients respond to fluids. The benefits of dynamic monitoring strategies in a range of patient populations have been borne out not only by meta-analyses but also recent clinical trial evidence. 

Target Audience:

Physicians and nurses in the following areas of specialty: Anesthesiology, critical care, emergency medicine, and surgery.

By the end of the session the participant will be able to:

• Describe the CMS goal of resuscitation in severe sepsis and septic shock.
• Recognize potential adverse outcomes of under and over resuscitation of the critically ill.
• Understand variability indices and changes in stroke volume to predict volume responsiveness.
• Recognize applications and limitations of non-invasive hemodynamic monitoring.
• Recognize potential benefits of guided volume resuscitation strategies.