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Terms & Conditions

Mission Statement

The mission of Provider Practice Essentials, Inc, is to provide resources, education, travel, and other services necessary to further the delivery of healthcare by providers (Physicians, Physician Assistants, Nurse Practitioners, and CRNAs) to patients in any healthcare setting.

Business Model

Provider Practice Essentials, Inc. (PPEMedical.com, here forth known as “Corporation”) is a Florida-Based medical education corporation. The Corporation, at its discretion, directly subcontracts members of its Planning Committee, Teaching Faculty, Educational Services, and other key components to satisfy all state, federal, and clinical board requirements of compliance.

Purpose of Program and Identification of Need

It has been recognized by many recent graduates from both Nurse Practitioner and Physician Assistant programs that there is a perceived paucity of hands-on training related to EKG interpretation, plain radiograph interpretation, and basic procedures during both the didactic and clinical rotation components of training programs.  This has been especially noted by graduates who have earned online degrees due to a limited amount of clinical exposure organized by their training programs.  Online programs lack a uniform clinical experience, standard clinical environment that ensures all recommended procedures are experienced, and often leave graduates seeking more exposure to the procedures and clinical skills aligned with the career paths they have chosen.

It is expected that by 2028, there will be a severe shortage of acute care providers to keep pace with an increased volume of high acuity, advanced age patients in our nation, and the clinical skills of these providers will be needed to enhance the physician work force.

It has also been noted that these limitations hinder the ability of new graduates to find clinical positions in high acuity/high procedure environments because they do not have minimum experience, which is typically expected to be 2 years post-graduation.  This course is designed to close this gap by presenting high-yield content to these practitioners in an effort to provide clinical confidence without resorting to on-the-job learning.  It is intended to structure the course content into a rational format to facilitate the application of clinical content to real-world practice.

The intent of this course is to provide additional training to participants to augment their clinical education and improve confidence in clinical decision-making, procedural skill, documentation and coding.  It is further intended to provide a certification pathway to validate the understanding of course material based on successful completion of the course and demonstrated mastery of its material.  Participants who successfully complete this course will receive a certificate of completion and continuing education credits, and may opt to take a certification examination, which will be valid for 2 years.  A recertification class will be offered, to allow participants to demonstrate continued mastery and also to educate practitioners about updates related to changes in standard of care, clinical guidelines, and compliance.

Those participants who choose to pursue certification from our program are required to score a combined 85% on a written and practical examination written, reviewed, and tested by our faculty.  Further validation to our examination is based on test market sampling and adjusted cumulative scores with statistical analysis to a true mean.  Exam questions will be clinically-based, similar in content to approved national board format, and directly related to areas that are perceived to be weaknesses to this provider population.  The Planning Committee and Faculty is composed of board certified physicians, Nurse Practitioners, and Physician Assistants, each whom have both clinical and administrative experience with the hiring, interviewing, and retention process, as well as the compliance and billing expertise required in today’s medical environment.  Our providers have combined experience as Medical Directors, Department Chairs, Expert Legal Witnesses, Clinical Professors, Paramedics, and educators with over 100 years of combined clinical experience.  Active clinical practice is a core requirement.

Providers who earn certification will receive a letter of reference from our Medical Director, Course Director, faculty physician, Nurse Practitioner Education Director, and Physician Assistant Education Director, as applicable by program.  It is our hope that those who choose to certify with our program will use this supporting documentation to gain employment in the field of their choice, and that it will be accepted as additional verification of their clinical competency.

Advanced Practice Provider Clinical Skills Workshop 1

Program Description 

“Advanced Practice Workshop for Primary, Urgent, and Emergency Care” is an intense, comprehensive 2-day course designed to incorporate lectures, video, handouts, simulation, and hands-on education of learner participants to bolster their respective professional education.  The primary focus of this course is to supplement education and provide confidence in skills identified as areas of weakness for providers who are newly out of training, transitioning from one medical specialty to another, or wish to enhance their current practice with currently accepted medical care and clinical guidelines.  There will be an additional focus to maximize compliance with federally mandated Physician Quality Reporting (PQRS) measures related to course content.

Program Audience

This course is designed for Physician Assistants and Nurse Practitioners who plan to practice in a primary care, urgent care, or emergency department setting.  It is also open to practitioners from all other specialties who wish to maintain their skills or learn additional skills to enhance their practice.  It is designed for a wide spectrum of providers ranging from those who do not have immediate life-saving capabilities on hand to those who work in trauma centers.  It is intended to serve as a reinforcement of skills to identify patients who may have lethal emergencies and reinforce identification of patients who need transfer to a facility with a higher level of care, and to recruit attending physician support in a reliable, appropriate, and resource-based fashion.

Core Program Faculty

The Program will be designed, planned, and educated by a committee that incudes at the minimum one Physician, one Physician Assistant, and one Nurse Practitioner, each certified by their respective certification boards. Core Faculty includes the following Members:

Robert P. Beatty, MD FACEP, Board Certified by the American College of Emergency Physicians (ACEP)

Rachel L. Beatty, MSN, FNP-BC, AG-ACNP-BC,CEN Board certified by the American Nurses Credentialing Center (ANCC)

In addition to core representation from each certification pathway (Nurse Practitioner and Physician Assistant), the course will have a Medical Director, Course Director, additional Physician Teaching Faculty, and additional Advance Practice Provider Faculty.  The Corporation is structured in such a way to expand course material and content to reach a wide variety of clinical audiences, and also expand staff to focus on individual markets for course delivery.

Learning Objectives of Course Components

The overall objective for this course will be to provide a structured supplemental skills training program that will allow the participant to broaden their basic clinical knowledge base, and also provide prospective employers, supervisors, and, when applicable, hospital credentialers documentation of their mastery of this material in the form of a certification that will be earned by passing an examination at the end of the program.  All participants will receive credit for completing the course, but only those who demonstrate mastery of the material will receive certification.  

Certification will not coincide with any known licensing board, academic program, university or affiliate, or accredited training program, but will provide verification of content understanding for those who achieve this distinction.  Certified providers will also receive a signed letter of verification from the supervising physician teaching their course that will serve to accompany their credentialing file.

The course will be divided into two comprehensive days of education, each day containing a morning and an afternoon session.  Morning sessions will be divided into 1 hour lecture blocks that focus on specific clinical content, and allow for interactive discussion, question and answer, and clinical examples.  Afternoon sessions will be dedicated to procedure workshops that are scheduled in tandem with previously presented clinical content to reinforce and enhance clinical content presented.  Please see sample schedule for further reference.  Upon completion, the Participant will be eligible to claim up to 15 hours of CE/CEU/CME credit for the course, and may be eligible to receive certification status.  The objectives of each portion of the program are as detailed below:

Cardiac Disorders– To enhance the provider’s understanding of basic principles of cardiac circulation, and to reinforce a systematic method of interpreting EKG’s to identify critical abnormalities that need immediate management by supervising physicians.  These specific abnormalities include:

1) ST Elevation Myocardial Infarction (STEMI) in the inferior, lateral, inferolateral, anterior, anterolateral and posterior sections of the heart.   (15 Minutes)

Learning Objectives:  1) To identify usual patterns of ST Elevation MI, 2) To identify patients with likelihood of multi-vessel disease, 3) To understand treatment modalities, pharmacology, and current guidelines for management of STEMI.  4) To review current management theory of STEMI in relation to use of Beta Blockers, Platelet Inhibibitors, and other classes of cardioselective medications.

2) Ventricular Tachycardia (15 Minutes)

Learning Objectives: 1) To understand morphology of VTACH and differentiate from mimics, 2) To understand safe treatment choices, 3) To consider additional cardiac diseases in patients with VTACH. (15 Min) 4) To reinforce management of ventricular tachycardia using Class 1a medications, Amiodarone, and other cardioselective medications.

3)Atrial  Fibrillation (15 Minutes)

Atrial Fibrillation with Rapid Ventricular Response 

Atrial Flutter

Slow Atrial Fibrillation

Learning Objectives:  1) To understand causes of new onset Atrial Fibrillation, 2) To differentiate from and treat variants of atrial fibrillation, 3) To understand appropriate disposition of Atrial Fibrillation patients. 4) To review common cardioselective medications – Beta-Blockers, Calcium channel blockers, for management of Atrial fibrillation.

4)Torsades des Pointes (15 Minutes)

Learning Objectives: 1) To differentiate TDP from VTACH, 2) understand how to appropriately treat TDP, 3) Learn to predict patient populations like to have TDP, 4) To understand electrolyte replacement strategies for potassium and magnesium in the setting of renal failure and other clinical conditions known to cause torsades de pointes.

5)1st, 2nd, and 3rd degree AV Blocks (15 Minutes)

Learning Objectives: 1) To unstand and identify differences between each type of AV block, 2) To understand treatment needs of each type of Block, 3) To understand modalities of treatment and specialist role of management. 

6)Multifocal Atrial Tachycardia (15 Minutes)

Sinus Tachycardia

Learning Objectives: 1) to understand the various types of tachycardia, 2) To place tachycardia into a broad clinical differential, 3) Understand what treatment options are specific to each type of tachycardia. 4) To consider the relative effect of Beta-Blockers, sympathomimetic agents and bronchodilaters on heart rate when managing COPD.

7)Bundle Branch Blocks (15 Min)

Learning Objectives: 1) To understand the types of cardiac blocks, 2)To clinically correlate cardiac blocks with relative underlying dsieases, 3)To interpret STEMI through a bunde branch block using Sgarbossa Critera. 

Program Participants will gain confidence and learn how to differentiate these rhythms and morphologies from each other.  Additional objectives of this portion of the program will be to comfortably identify EKG abnormalities in a random fashion and in combination with the patient’s clinical picture.  Finally, any relevant Core measures and PQRS standards will be reviewed and their applicability applied to the appropriate clinical environment.

Pulmonary (1 hour)

The objectives of this program portion will be for each participant to perform the following parts of basic patient examination:

8) Basic Airway and Breathing Assessment (15 Minutes)

Learning Objectives: 1) Identification of suspected airway obstruction, 2) 

Identification of Stridor and likely causes, 3) Understand when to suspect non-traumatic of Pneumothorax and patient populations involved. 

9) Additional Objectives will be to reinforce current decision-making rules for ordering of appropriate tests, and anticipating procedural intervention (15 Min).  These include:

Application of Wells Criteria for Pulmonary Embolism

Application of the PERC rule

Identification of populations who are at high risk for Pulmonary Embolism

Appropriate use of the D-Dimer

Prediction of severity of Asthma using Peak Flow Meter

Understand the mechanisms of common bronchodilators for management of Asthma and COPD.

Understand selection strategies for anticoagulants (Heparin, LMWH, Xa Inhibitors in the setting of PE/DVT.

Procedural Objectives will be to intervene with appropriate management when clinical conditions arise.  These procedures will include:

10) Tracheostomy replacement (for patients with routine established tracheostomy) (15 Minutes)

Learning Objectives: 1) To understand the different types of tracheostomy tubes, 2) To understand how they are placed and maintained, 3) To become comfortable with tracheostomy exchange in patients with mature stoma.

11) Needle Decompression (15 Minutes)

Learning Objectives: 1) To understand the indication for Needle Decompression, 2) To understand the principle behind the procedure of needle decompression, 3) To demonstrate clinical ability of placement of needle thoracostomy.

12) Chest Tube Insertion (using percutaneous kit) (30 Minutes)

Learning Objectives: 1) To understand the indication for chest tube insertion, 2) To differentiate between different types of chest tubes and their indications, 3) To demonstrate clinical ability to insert a chest tube. 4) Understand the procedural analgesia approach of regional nerve block, chest wall nerve block, and intrathoracic nerve block prior to procedure.

Practice-related objectives will include education and adherence to appropriate quality-based treatment decisions and documentation related to asthma, bronchitis, upper respiratory infection, and other common pulmonary complaints.

Additional focus will be placed on provider quality reporting measures, complete documentation, and other tools designed to maximize medical communication through improved documentation while increasing charting compliance and reducing reviews and payment denials to supervising physicians.

Radiology 

This portion of the program is intended to be an enhanced review of the various types of radiology studies, appropriate utilization and technique of the studies being ordered, and quality-based decision-making related to studies that are part of the PQRS program.  This will be a system-focused portion of the program, with the primary objective being to educate the participant that a broad differential diagnosis should be considered when examining each patient, and to reinforce the need to apply this broad differential when ordering studies and treatment.  Each section of the human body will be presented to the participant, who will be given a comparison course book with normal anatomy to compare to a sequence of pathologic radiographs for review, comparison, and diagnosis.  The intent of these modules is not to expect the participant to memorize and learn the details and nuances of a variety of fractures, but to learn mechanisms and patterns of disease and fractures that should be considered and identified in routine practice.  

In addition to plain film ordering and fracture diagnosis, learning about the appropriate immobilization/splinting and referral for routine fractures will also be taught with the objective that each participant have a working understanding of which fractures types require emergent management, urgent follow-up, routine follow-up, or expectant management.  Paramount to practicing in the role of an Advanced Practice Provider will be the ability to communicate fracture findings to the receiving consultant, and the appropriate nomenclature will be reinforced.  It will be an objective to present and briefly discuss the origin of each of the following radiographic findings:

13) Chest/Abdomen (1 Hour)

Learning Objectives:  1) To differentiate between the different types of abdominal imaging.  2) To understand the indiciations for oral and IV contrast for CT imaging, 3) To understand different studies indicated for different patient populations (i.e. pregnancy), 4) To demonstrate ability to interpret plain radiographs of the chest and abdomen: 

  • Pneumonia
  • Pneumothorax
  • Hemothorax
  • Hiatal hernia
  • Perforated viscous
  • Pneumopericardium
  • Pneumomediastinum
  • Pericardial effusion
  • Pleural effusion
  • Empyema
  • Rib fractures
  • Shoulder/humerus fractures
  • Scapula fractures
  • Clavicle fractures
  • Signs of high impact injury
  • Constipation
  • Bowel Obstruction
  • Porcelain Gallbladder
  • Gallstones
  • Foreign Bodies

14) Spine (45 Minutes)

Learning Objectives:  1) To associate mechanism of injury with type of fracture, 2) To understand stable versus unstable fractures of the cervical spine, 3) To learn appropriate clearance of the cervical spine, 4) to demonstrate inline mobilization and placement of a cervical collar. 4) To understand the role of specialty consultation and referral with cervical spine fractures:

  • X-ray interpretations 
  • Long board and collar removal
  • Unstable Fractures
  • Mechanisms for common fractures
  • Immobilization
  • Correct studies
  • Correct consult and referral

15) Nexus Criteria (15 Minutes)

Learning Objectives: 1) Understand appropriate use and application of the clinical decision rule for cervical spine clearance. 2) Understand limitations to NEXUS application, 3) Understand appropriate documentation of clinical decision rule and outcome.

16) Other spinal fractures and considerations (30 Minutes)

Learning Objectives: 1) Understand additional spinal fractures and their management, 2) Understand resource utilization and clinical utility of imaging in low back pain. 3) Understand and identify life-threatening and disabling disorders of the back, and their appropriate diagnosis and referral, 4) Correlate clinical findings to radiographic findings for back pain and other disorders of the spine:

  • Plain film reading
  • Lumbar spine imaging
  • Cauda Equina syndrome
  • Epidural abscess
  • When to order an MRI
  • Neurological exam findings

17) Upper Extremity images (1 Hour)

Learning Objectives: 1) To understand mechanism and expected fracture associations, 2) To identify common fracture patterns on plain radiographs, 3) To understand appropriate disposition of various fracture types, 4) To understand the appropriate immobilization needed for upper extremity injuries.

  • Shoulder dislocations and reduction techniques without sedation
  • Hill-sacs deformity
  • AC separation
  • Humeral head fracture
  • Humeral neck fracture
  • Surgical neck fracture
  • Supracondylar fracture (pediatrics)
  • Elbow dislocation and reduction
  • Radial head fracture
  • Galeazzi fracture
  • Monteggia fracture
  • Distal radius fracture
  • Ulnar fracture
  • Nightstick fracture
  • Greenstick fracture
  • Hand Fractures
  • Carpal fractures and dislocations
  • Metacarpal fractures
  • Boxers fracture
  • Finger fractures
  • Fingertip amputations
  • When to consult ortho

18) Pelvis and lower extremity images  (1 Hour)

Learning Objectives: 1) To correlate injury type and mechanism with expected fracture patterns on plain films. 2) To understand which fracutres need emergent reduction and consultation.  3) To understand method of routine disposition, 4) To understand which types of immobilization are required for management of lower extremit

  • Pelvic Fracture
  • Acetabular Fracture
  • Hip Fractures
  • Femur Fractures
  • Knee hyperextension and vascular injury
  • Patellar Fracture
  • Tibial Plateau Fracture
  • Maissoneuve Fracture
  • Tib/Fib Fractures
  • Bimalleolar Fracture
  • Trimalleolar Fracture
  • Tarsal Fracture
  • Tarsal Dislocation
  • Lisfranc Fractures
  • Metatarsal Fractures
  • Dancer’s Fracture
  • Toe Fractures
  • Distal Toe Amputations

19) Skin and Soft Tissue Conditions (30 Minutes)

This portion of the program is designed to provide participants with a structured, systematic process to evaluate all skin lesions as they present frequently in the primary care, urgent care, and emergency department setting.  The objective will be for all participants to gain a level of comfort excluding life-threatening skin conditions prior to treating them, and also have the confidence to better communicate their findings to higher levels of care.  These conditions will include the following:

  • Emergent Rash Identification (meningitis, Stevens-Johnson Syndrome, Erythema Multiforme, Toxic Epidermal Necrolysis, Necrotizing Fasciitis)
  • Cellulitis
  • Abscess
  • DVT identification and decision rules with D-Dimer
  • Burn Care
  • Burn Referral Criteria
  • What not to send home.
  • Understand anticoagulation options for DVT (Heparin, LMWH, Factor Xa Inhibitors) and their utility in the clinical setting.
  • Understand regional injection for analgesia prior to abscess incision and drainage.
  • Understand medication choices for routine management of mild to moderate allergic reactions (Epinephrine, Diphenhydramine, H2 Blockers, and Steroids).

Procedures 

This portion of the program will allow the participant to practice a variety of common procedures performed in the primary care office, urgent care, or emergency department setting, and is timed and organized to complement the clinical didactic section presented on the same days.  Participants will be given the latest mannequin and simulation products to practice and improve their techniques.  The Objective of this portion is to educate and demonstrate proper technique to perform these procedures, and to reinforce the confidence level of the practitioner to perform these procedures in the clinical setting.  In addition, relevant pharmacologic interventions will be presented as clinically appropriate to procedure being performed.  Skill will be assessed and scored by the teaching faculty, and performance review will be included along with the written didactic test for those wishing to be certified.  The complete procedure list will consist of many physical stations during the program, but due to supply availability, discontinued stock, or other logistical reasons, not every skill session may be available on the date(s) of the training program.  The Corporation will make every effort to ensure that the following procedure stations are available at each course:

  • Needle Decompression
  • Chest Tube insertion
  • Tracheostomy replacement
  1. 20)Upper Extremity Fracture reductions (30 Minutes)

Learning Objectives: 1) To understand when emergent reduction of the upper extremity is indicated. 2) To understand the role of sedation with upper extremity reduction, 3) To demonstrate proper reduction techniques.

  1. 21)Upper extremity splinting (Long Arm, Short Arm, Sugar Tong, Ulnar Gutter) (30 Minutes)

Learning Objectives: 1) To understand the different types of splints used for upper extremity immobilization. 2) To demonstrate appropriate clinical skill for placement of splints on the upper extremities. 3) To demonstrate technique for post-splint examination.

  1. 22)Upper extremity joint aspiration (30 Minutes)

Learning Objectives: 1) To identify the indications for upper extremity joint aspiration. 2) To demonstrate landmarks used for identification of aspiration site, 3) To demonstrate clinical skill to perform joint aspiration.

  1. 23)Trigger Point Injection (15 Minutes)

Learning Objectives 1) To understand clinical diagnosis of trigger point. 2) To understand indications for trigger point injection. 3) To demonstrate clinical skill of joint aspiration.

  1. 24)Nail Trephination and Nail Removal (15 Minutes)

Learning Objectives: 1) to identify clinical indications for trephination versus removal of the nails. 2) To identify high risk populations related to this procedures (diabetics, smokers), 3) To understand clinical outcomes of this procedure

  1. 25)Punch Biopsy (15 Minutes)

Learning Objectives: 1) To identify lesions that require biopsy in the primary care setting, 2) To describe the procedure and risks of benefits to the patients, 3) To demonstrate skill of performing the procedure.

  1. 26)Foreign body/fish hook removal (15 Minutes)

Learning Objectives:  1) Understanding of various types of soft tissue foreign bodies and their appropriate management. 2) Understaning of fishhook injuries in general and different techniques for removal.  3) Deomonstration of understanding of safe ways to perform foreign body removal fro soft tissues.

  1. 27)Introduction to Suturing (30 min)

Learning Objectives:  1) To understand and differentiate the different types of suturing techniques that are commonly used.  2) To understand which types of repair are needed for different tissue injuries and lacerations  3) to demonstrate appropriate selection of closure technique.  4) To demonstrate clinical skill and mastery of each type of suture technique and knot tying.  5) To understand multiple-layer injuries and the appropriate technique for closure of each tissue layer.  6) To understand the appropriate documentation for all laceration repairs.  Techniques, knots, and topics will include the following:

    1. a.Simple interrupted
    2. b.Simple running
    3. c.Mattress
    4. d.Subcutaneous/multi layer
    5. e.Staple
    6. Skin adhesive
    7. g.Surgeons knot
    8. h.Buried knot
    9. Documentation for complexity
  1. 28)Local injection, digital blocks, Hematoma Blocks (30 Minutes)

Learning Objectives: 1) To understand different techniques for local anesthesia, including topical applications, 2) To understand the anatomical landmarks, risks, and benefits of, and procedure for digital block, regional joint block, and hematoma block, 3)To demonstrate skill and performance of digital block.

  1. 29)Lumbar Puncture (30 Minutes)

Learning Objectives:  1) To understand the indications, contraindications, and purpose for performing a lumbar puncture.  2) To understand the lumbar puncture as a procedure and the core studies that should be ordered with a CSF sample.  3) To demonstrate procedural skill by performing a Lumbar Puncture.

  1. 30)Incision and Drainage of Abscess (15 Minutes)

Learning Objectives:  1) To differentiate clinically between an abscess, sebaceous cyst, infected sebaceous cyst, and soft tissue mass.  2) To understand the common approach to incision and drainage of an abscess.  3) To demonstrate clinical procedural ability to perform incision and drainage.

  1. 31)Joint Reduction (30 Minutes)

Learning Objectives:  1) To anticipate the type of joint dislocation based on mechanism, anatomic position of extremity, and patient presentation. 2) To understand the correlation of radiograph findings and reduction approach. 3) To differentiate between the different types of reduction approaches, 4) To know when operative management is warranted, 5) to understand referral and post-reduction management.  Joints educated will include:

    1. a.Patella Reduction
    2. b.Ankle Reduction
    3. c.Hip Reduction
  1. 32)Lower Extremity Splinting (30 Minutes)

Learning Objectives: 1) Understand appropriate splint application for lower extremity injuries. 2) Identify radiographic correlation to splint placement, 3) Demonstrate clinical procedural skill and placement of lower extremity splints.

  1. 33)Lower Extremity Joint Aspiration (30 Minutes)

Learning Objectives: 1) Understand indications for joint aspiration.  2) Understand diagnosis of condition based on fluid sample.  3) Understand procedural approach to joint aspiration and proper technique.  4) Understand contraindications of joint aspiration.  5) Demonstrate clinical procedural skill of joint aspiration.

  1. 34)IO Access (15 Minutes)

Learning Objectives:  1) Understand indications, contraindications, complications, and utility of Intraosseus lines as alternative types of venous access.  2) Identify and understand common sites of Intraosseus line placement and techniques for insertion.  3) Demonstrate clinical procedural skill of Intraosseous insertion

  1. 35)Central Venous Catheter Insertion (45 Minutes)

Learning Objectives:  1) Understand indications, contraindications, complications, utility, and site preference of central venous catheter insertion.  2) Understand procedural technique, approaches to common difficulties with the procedure, and correct placement confirmation. 3) Demonstrate clinical procedural skill of Intraosseous line insertion.

  1. 36)Optional Comprehensive Course Test (1 Hour)

Learning objectives:  1) Combine clinical, procedural, quality, and management goals educated in this program into a review test designed to cement course content into the Learner’s core knowledge content.  2) Apply medical decision-making to board-style review questions with a goal to achieve a raw score of 85%.  3) Gain confidence and verification of knowledge that can be transferred to an application packet and used as a resource for the learner.

Medical Specialty Courses

Provider Practice Essentials will offer focused training and board review courses for Nurse Practitioners and Physician Assistants wishing to apply credits earned towards certification within their individual certification boards.  Provider Practice Essentials will maintain accreditation through an appropriate organization that will allow credits to be applied toward these requirements.  The participant acknowledges that application of earned credits toward this additional certification requirement will be at the ultimate discretion of the board and/or certification body certifying the participant, and will hold Provider Practice Essentials and its subsidiaries harmless from claims resulting in fewer credits than anticipated being applied toward certification.  Participants in this program are encouraged and recommended to contact their certification board(s) to confirm that requirements are suitable for their goals.

Board Review Courses

Provider Practice Essentials will utilize any public information available to design focused board review materials by specialty.  Using Emergency Medicine as an example (but not limited to this specialty), new speciality certifications or those that have changed their requirements will have very limited information regarding their material.  Provider Practice Essentials will provide numerous materials in the form of live lecture, online multimedia review, test questions, and resources aimed at providing a well-rounded review approach to commonly tested material across the specialty.  We do not warranty ourselves as having any inside information or unique details that give us an academic edge for board examination preparation or content.  Participants of our board review series understand that no organization other than the one writing and validating the actual certification examinations will have any knowledge about specific board material other than commonly tested topics, topics routinely found in practice within the specialty, and any material published for general review by the organization which we provide review materials for.  Participants acknowledge that academic learning and application of clinical concepts is an individualized process, and that providing a platform for the learning of material does not inherently guarantee mastery of skills or transference of the knowledge base necessary to successfully pass a written or practical board exam.  Participant further acknowledges that our board review materials are little more than a tool to focus on learning objectives in an organized fashion, and in no way represent the actual experience of board certification examination.  The participant agrees to hold Provider Practice Essentials, LLC, and/or its collaborators or subsidiaries harmless from any failure to successfully pass a qualifying examination, or obtain a necessary certification for their intended specialty.  An intended specialty will be defined as the specialty for which a board review program has been ordered (I.e. if a customer purchases an internal medicine board review series, it will be assumed that their intended specialty will be internal medicine).

Medium used for Programs

Given the diversity of both didactic and procedural training methods in our program, a combination of printed, web-based, computer-based, video, audio, and mannequin-supported simulation media will be used, where appropriate, to deliver the intended training content.  In addition, authentic medical supplies will be used for all portions of the procedure education.  Participants will be given an additional resource kit for their own practice as part of the course.

Live Human Models

Whenever necessary, live human models may be used to assist with education.  Their application may include Ultrasound, anatomy, and other relevant hands-on exposure to students who take our programs.  Prior to being approved as a live model, all models must review and agree to a waiver holding the Company, it’s facilitators, and it’s attendees harmless from missed diagnosis.  Models have all clearly agreed that the Company in no way, shape, or form, will provide medical advice to them.  All models also understand and have agreed to visit their personal physician for any medical questions, and that participation in our programs in no way whatsoever creates, enforces, defines, or remotely suggests that a clinician-patient relationship exists.

Evaluation Process

At the end of the course, each participant will complete a survey, either in written or electronic format, to comment and give feedback on key components of the program and its faculty.  Please see the attached sample survey for more information.

Commercial Involvement

All components of this Program are free of commercial control influence.  To that end, there are no preferred brands, trademarks, affiliations, or other entities that have been or will be given access to any aspect of this program, not limited to the identification of CME needs, determination of education objectives, selection and presentation of content, selection of all individuals of and organizations that will be in a position to control the content of the CME, selection of educational methods, and evaluation of the activity.  There is no partnership, accredited or non-accredited with any commercial interest as a joint provider.  All content and format of this activity is free of commercial bias and constructed for the sole purpose of communicating and educating patient care methods and clinical practice guidelines in the interest of improving the delivery of patient care.  Wherever possible, generic names are used without intended reference to specific brand names, and no connection between a brand name and any affiliation is inferred.  Supplies for this program are obtained through numerous third party outlets, and do not represent a contracted relationship between any branded material, their manufacturer, and the provider of this educational activity.  CORPORATION will disclose to all learners any Faculty, educational planning committee members, and other individuals determined to hold a position requiring disclosure of relevant financial relationships, and will disclose the name of the individual, name of commercial interest(s), and the nature of the relationship the individual has with each commercial interest.  If an individual has no relevant financial relationship(s), learners will be informed that no such relationship exists.  Learners will be informed of any commercial support for this program, should it exist, and the nature of this support will be disclosed if the commercial support is “in kind.”  All providers who are in a position to control the content of this educational activity and have a relevant financial relationship within the past 12 months that creates a conflict of interest must disclose this relationship and the provider will document such disclosures.  Any individual who refuses to disclose any financial relationship(s) will be disqualified from any participation in any educational activity, in any form, and may not participate with any components of CME activities within Corporation.  All members of the CORPORATION educational team will have any and all conflicts of interest resolved prior to their participation of any aspect of CME activities.  Resolution of Conflicts of interest will be resolved in accordance with the designated policies of any affiliated body providing CME credits, including the American Academy of Physician Assistants, The American Academy of Nurse Practitioners, and the American Medical Association, as applicable to the credentials conferred to the specific educational activity in question.

Appropriate Use of Commercial Support

  1. THE COMPANY will make all decisions regarding the disposition and disbursement of commercial support. 
  2. THE COMPANY will not be required by a commercial interest or its surrogate to accept advice or services concerning teachers, authors, or participants or other education matters, including content, from a commercial interest or its surrogate as conditions of contributing funds or services. 
  3. All commercial support associated with a CME activity will be given with the full knowledge and approval of THE COMPANY.. 
  4. The terms, conditions, and purposes of the commercial support will be documented in a written agreement between the commercial supporter and the provider that includes its educational partner(s), if applicable. The agreement will include Corporation  (party responsible for activity execution) even if the activity has an educational partner or joint provider. 
  1. The written agreement specifies the commercial interest that is the source of commercial support.  Both the commercial supporter and THE COMPANY have signed any written agreement between the commercial supporter and THE COMPANY. 
  2. THE COMPANY has written policies and procedures governing honoraria and reimbursement for outofpocket expenses for planners, faculty and authors. 
  3. THE COMPANY, any joint provider, or designated educational partner will directly pay any faculty or author honoraria or reimbursement for outofpocket expenses in compliance with our own written policies and procedures, and any individually contracted arrangements. 
  4. No other payment shall be given to the director of the activity, planning committee members, teachers, faculty, or authors, joint provider, or any others involved with the supported activity. 
  5. If teachers, faculty or authors are listed on the agenda as facilitating or conducting a presentation or session, but participate in the remainder of an educational event as a learner, their expenses will be reimbursed and honoraria will be paid for their teacher, faculty, or author role only. 
  6. Social events or meals at CME activities will not compete with or take precedence over educational events. 
  7. THE COMPANY will not use commercial support to pay for travel, lodging, honoraria, or personal expenses for nonteacher, nonfaculty or nonauthor participants of a CME activity. THE COMPANY may use commercial support to pay for travel, lodging, honoraria, or personal expenses for bona fide employees and volunteers of THE COMPANY, joint provider or educational partner. 
  8. THE COMPANY will maintain accurate documentation detailing the receipt and expenditure of the commercial support as well as all other funds. 

Appropriate Management of Associated Commercial Promotion

  1. Arrangements for commercial exhibits or advertisements do not influence planning or interfere with the presentation, nor are they a condition of the provision of commercial support for CME activities. 
  2. Product promotion or productspecific advertisement of any type is prohibited in or during CME activities. The juxtaposition of editorial and advertising material on the same products or subjects must be avoided. 
    1. Live (staffed exhibits, presentations) or enduring (printed or electronic advertisements).
    2. Promotional activities are kept separate from CME.
    3. For print, advertisements and promotional materials will not be interleafed within the pages of the CME content. Advertisements and promotional materials may face the first or last pages of printed CME content as long as these materials are not related to the CME content they face and are not paid for by the commercial supporters of the CME activity. 
    4. For computer based, advertisements and promotional materials will not be visible on the screen at the same time as the CME content and not interleafed between computer ‘windows’ or screens of the CME content. Also, providers may not place their CME activities on a Web site owned or controlled by a commercial interest. With clear notification that the learner is leaving the educational Web site, links from the Web site of a provider to pharmaceutical and device manufacturers’ product Web sites are permitted before or after the educational content of a CME activity, but shall not be embedded in the educational content of a CME activity. Advertising of any type is prohibited within the educational content of CME activities on the Internet including, but not limited to, banner ads, subliminal ads, and popup window ads. For computer based CME activities, advertisements and promotional materials may not be visible on the screen at the same time as the CME content and not interleafed between computer windows or screens of the CME content. 
    5. For audio and video recording, advertisements and promotional materials will not be included within the CME. 
    6. There will be no ‘commercial breaks.’ 
    7. For live, facetoface CME, advertisements and promotional materials cannot be displayed or distributed in the educational space immediately before, during, or after a CME activity. Providers cannot allow representatives of Commercial Interests to engage in sales or promotional activities while in the space or place of the CME activity. 
    8. For Journalbased CME, None of the elements of journalbased CME can contain any advertising or product group messages of commercial interests. The learner must not encounter advertising within the pages of the article or within the pages of the related questions or evaluation materials. 
  3. Educational materials that are part of a CME activity, such as slides, abstracts and handouts, may not contain any advertising, corporate logo, trade name or a productgroup message of an ACCMEdefined commercial interest. 
  4. Print or electronic information distributed about the nonCME elements of a CME activity that are not directly related to the transfer of education to the learner, such as schedules and content descriptions, may include productpromotion materials or productspecific advertisement. 
  5. THE CORPORATION will not use a commercial interest as the agent providing a CME activity to learners, e.g. distribution of selfstudy CME activities or arranging for electronic access to CME activities. 

Venue Selection

Educational activities that occur in a hotel or other privately owned building are scheduled in advance and contracted between the venue and THE CORPORATION.  This contracting process does not create or imply that any form of commercial support from the venue to THE CORPORATION exists.  Contracts are negotiated for venue as part of usual business to secure a training location, and are not tied to the type of education.  Any additional venue services (reduced hotel rates, meals, discounts, etc.) are the result of the negotiated and contracted event service between THE CORPORATION and the venue, and are independent of any CME activity.  Such services are not intended to imply that any preferred vendor relationship, commercial influence, or commercially driven educational content exists. 

Room Reservation and Hotel Booking Policy

Hotel accommodations may be booked several ways during the registration process.  Customers may book online via a direct link to the hotel, which is provided on each registration page, or by calling the hotel directly to arrange room reservations.  Customers referred to our website by our partners may choose to pay an all-inclusive price through our website at the time of registration.  This payment is made to the company, and reservation requests are forwarded to the hotel for approval and booking.  The Company does not make any guarantee regarding room availability, and has asked hotels to notify them when rooms or specific room types are not available.  Hotels have been asked to provide customers with confirmation codes to confirm reservations that have been made.  In the event a hotel sells out prior to a customer booking a room, and online booking is made before the room availability has been updated by the Company, either the hotel, the Company, or both will make a good faith effort to contact the customer and notify them that a room is no longer available at the property they requested, and seek alternative arrangements.  It is understood that the customer may ultimately be responsible for any additional charges incurred by hotels reserved in good faith outside of the advertised rooms on the website.  The customer understands that ALL ROOM RESERVATIONS PURCHASED FROM THE COMPANY ARE NON-REFUNDABLE.  The Company assumes no liability for unavailable or lost room reservations not recognized in a reasonable time by the customer.  Customer agrees to hold corporation harmless from damages resulting from their failure to secure a room reservation, including lost airfare, travel costs, higher room costs at other hotels, lost course registration charges, and any and all other costs alleged to be incurred as a result of unavailable or lost room reservations.  Customer agrees that all room reservations are their responsibility to confirm, maintain, and verify, and that the Company is providing a service to merely assist them with making reservation(s).  The Customer understands that the Company is not responsible for any rooms booked by the customer outside the sale of the educational event.

Rescheduling Policy

The Customer understands that by reserving a seat in one of the company’s programs, they are assuming liability for changes that may effect course income, either directly or indirectly.  The Customer further understands that the costs incurred by the corporation to hold a single event may include contracted food and beverage minimum fees, minimum room rental blocks, and other expenses that are budgeted, in advance, before the course date – often times months in advance.  The Customer understands that rescheduling of their reservation (makeup course) may subject the corporation to lost deposits, fees, and penalties charged by hotels and/or venues, which may not be recoverable at certain venues.  For these reasons, ALL REQUESTS TO RESCHEDULE ATTENDANCE FROM A PREVIOUSLY RESERVED EVENT WILL REQUIRE A $250.00 RESCHEDULING FEE.  THIS INCLUDES ADDITIONAL EVENTS THAT HAVE BEEN PREVIOUSLY RESCHEDULED AND ARE REQUESTED TO BE RESCHEDULED AGAIN.  In addition, PREPAYMENTS FOR HOTEL COSTS MADE TO THE COMPANY WILL BE NON-REFUNDABLE.  The Customer understands that a repeat payment for hotel fees will be required if overnight lodging is requested, and will be determined by the company’s advertised rate at the time of registration. The Corporation reserves the right to reschedule courses based on unexpected conditions, natural disasters, disease outbreaks, epidemics, pandemics, or other unforeseeable events that are detrimental to the operational safety of the scheduled program.  In  the event such cancellation is necessary, Customers will be rescheduled for the next available program at their convenience.  A maximum of 1 scheduled change is permitted per customer unless approved by the Corporation.  All rescheduling changes must occur within one calendar year from the original date reserved and may not be permitted based on occupancy of the replacement date requested.  This will be at the sole discretion of the Company.  The Customer understands and agrees that ALL FEES PAID TO ATTEND A PROGRAM MAY BE NON-REFUNDABLE IF THEY ARE UNABLE TO ATTEND THE PROGRAM FOR WHICH THEY ARE REGISTERED.

Refund Policy

All requests for refunds must be made in writing or email format.  Refunds for program fees (defined as the total sum of any payments made excluding hotel reservations) are determined based on a pro-rated schedule prior to the date of the program as follows:

91 or more days prior to the program date:  All program fees are fully refundable minus a $250 reservation fee.

90 to 61 days prior to the program date:  50% of the total program fees will be eligible for a refund 

60 to 31 days prior to the program date:  25% of the total program fees will be eligible for a refund  

NO REFUNDS WILL BE GIVEN FOR CUSTOMER CANCELLATIONS WITHIN 30 DAYS OF THE SCHEDULED EVENT.  

HOTEL BOOKING FEES ARE NOT ELIGIBLE FOR REFUNDS REGARDLESS OF DATE OF REFUND REQUEST.

ALL ONLINE CONTENT PURCHASES (INCLUDING MEMBERSHIPS, REVIEW PROGRAMS, LECTURES, OR OTHER ITEMS PURCHASED THROUGH THE COMPANY WEBSITE OR ITS REFERRAL SOURCES, AND NOT DESIGNATED AS LIVE EVENTS) ARE NON-REFUNDABLE.  ALL SALES ARE FINAL FOR THESE PRODUCTS.

The Customer acknowledges that this refund policy exists for the protection of the Company and its contracted relationships with the venues where it holds events.  The customer further understands that the language used herein and acknowledgment and acceptance of these terms and conditions is binding and will serve as rebuttal in the event of a dispute or review of charges.  In the event that a customer’s charge or purchase is disputed by the Customer, reviewed by the appropriate process dictated by the customer’s crediting/payment authorization agency, and decided in favor of the Company, the customer agrees to pay the Company $500.00 for time spent defending their dispute if the findings are found to be contained in these terms and conditions.  The customer further agrees to exhaust all attempts to contact the Company (by email, text message, written letter) prior to disputing charges through their credit/debit card agency.

Subscription and Online Membership Terms and Conditions

The Purchase of a WEBSITE MEMBERSHIP includes a one-time $99.00 registration fee and an initial annually recurring subscription fee of $49.99.  Registration for LIVE PROGRAMS includes a complimentary one year membership to our online clinical resources portal and members-only content.  Unless cancellation is requested specifically in writing, or by electronic cancellation through our website after the user has logged in, there will be an annual charge of $49.99 for RECURRENT SUBSCRIPTION to this benefit, which will be charged on the anniversary of the initial purchase date.  The Customer permits the company to make annually recurring installment charges in this amount and acknowledges that AGREEMENT WITH THESE TERMS AND CONDITIONS SERVE AS AUTHORIZATION FOR RECURRENT INSTALLMENT CHARGES FROM THE COMPANY ON THE CARD USED FOR INITIAL PURCHASE.  ALL SUBSCRIPTION CHARGES ARE NON-REFUNDABLE.  In the event that an annual subscription renewal charge is declined, the Company may terminate the customer’s membership immediately.  The Customer further gives consent to the Company to utilize third party charging and billing services to routinely update credit/charge card information provided by the Customer and modify information based on card expiration dates, replacement cards, and other changes to the Customer’s payment sources reported to these third parties.  Provider Practice Essentials, LLC does not store or retain any customer payment information on their website. 

Cancellation Policy

The Company reserves the right to cancel any live programs at their sole discretion.  Further, it is understood by all parties that the Corporation will be held harmless for cancellations related to weather disruptions, emergencies, epidemics, pandemics, mandatory or suggested government quarantines, evacuations, force majure, acts of God, war, or other reasons stipulated by the venues contracted by corporation as a result of their cancellation and inability to host this program.  The Corporation reserves the right to enforce the refund policy above, and may make exceptions on a case-by-case basis.

Social Media Policy

Provider Practice Essentials, Incorporated will use social media as a platform to advertise, enroll, recruit, and network with businesses, clients, facilities, certification boards, colleges, universities, and other entities that it deems fit for the usual operation of its business practice.  It is understood that such a platform permits two-way and third party discussion in the form of posts, threads, satisfaction feedback, and reviews.  The Company. reserves the right, within the boundaries and contractual obligations of the social media platform that it uses, to remove reviews, posts, comments, pictures, or any other content that it deems as inappropriate, inaccurate, slanderous, derogatory, or otherwise harmful to its usual business operations.  Further, the Company reserves the right to pursue legal enforcement and protection of its business entity in accordance with any local or federal statues preserving the rights of free trade, business protection, personal protection, or other statues as deemed appropriate for enforcement by its members.

Notification of Allergy-Sensitive Materials

In an effort to maintain availability of materials, remain competitive as a education program, and provide the most current and advanced materials for your education experience, it is impossible for us to provide a latex-free environment,  If you have a latex allergy, or are sensitive to latex products, please consider that you will be in a room that contains, and in close proximity to latex-based simulation mannequins, hands-on suture material/simulators, and additional medical equipment that will contain latex.  If you are concerned that you have a severe latex allergy, that may become a life-threatening condition, it is your responsibility to consider this course and determine if it is a safe fit for your safety.  The Company will not assume any liability for any injury that you incur should you choose to take this course with a known allergic condition.

Injury

By participating in this course I acknowledge that I will be using equipment that may cause physical injury to myself or others.  I will govern myself accordingly and will not hold Provider Practice Essentials liable for any injury that occurs during this program.  I forever waive my right to litigate against Provider Practice Essentials, and hold them harmless from any claims that result in or from my injury.

Third Party (Group) Contracting and Custom Programs

Provider Practice Essentials may, from time to time, contract with outside companies, medical practices, and groups of providers to develop and provide customized or personally scheduled events.  These events may incur substantial cost, additional resources, and are not without added risk to the Company.  In these cases, the Company will provide a separate agreement for these such events.  The terms and conditions of individual group agreements will supersede the terms contained herein, unless otherwise specified in the separate agreement.

Participant Agreement

The Customer agrees that checkbox acknowledgement of these terms and conditions, confirms that review of all items in these terms and conditions has occurred by the Customer, verifies that the course description and objectives enclosed herein are accurate and correct, attests that the customer is an appropriate member of the target audience for the educational opportunity for which the customer has registered, and that the customer has read, understood, and agrees with all aspects of the terms, and conditions.

By checking the box to enable purchase, the customer or their designee forever releases and holds Provider Practice Essentials, Incorporated and any affiliated contracted entities, related or unrelated this activity, including faculty members, planning committee members, joint corporations, contracted vendors, and contracted venues harmless from all liability related to personal, emotional, physical, or any other injury, damage, tort, or specific or nonspecific outcome that occurs during this educational session.  

By checking the box to enable purchase the customer understands that this course is neither a replacement for board certification by an accredited board, nor a replacement for actual patient contact and experience, and may not qualify for CME, CE, or CEU credits that are required by the licensing board(s) under which the customer may be currently licensed.  The customer further understands that board or credentialing agencies may require submission of a certificate of completion for consideration of awarding education credit, and that if such credit is not awarded, it is not the responsibility of Provider Practice Essentials or it’s agents to pursue.  

By checking the box to enable purchase, the customer also acknowledges that the completion of necessary requirements to obtain certificates of completion, continuing education, and reporting of earned credits are the responsibility of the customer to be completed within 6 months of the date of the program qualifying for such a certificate to be awarded.  The Company has the right to charge a convenience fee not to exceed $100 for processing and creation of certificates or verification documents that were not correctly obtained or lost by the Customer.

The customer further acknowledges by that certification from this program reflects attendance and mastery of the course material hereto attached, and expires 1 year from the date of course completion.  It is understood that certification is optional and does not represent itself to be a substitute for a formal training degree, credential, or other board certification.  

By checking the box to enable purchase, the customer consents to have their photograph taken as part of Company documentation, Company advertisement, website publication, and any other use deemed appropriate for the normal business operation of the Company.  The Customer authorizes use of their image in this regard, and releases the company from liability for the use of their image in any manner the company desires. The Customer understands that in the event they do not wish to be photographed, they will inform the Company in writing prior to placing themselves in a situation where the photograph may be obtained.  Provider Practice Essentials, its subsidiaries, its agents, faculty, and board will ensure that the Customer’s privacy is respected.  Further, the customer agrees that in the event they do not wish to be photographed, they will make every effort to remove themselves from any location where they may be inadvertently photographed.   

By checking the box to enable purchase, The customer agrees that Provider Practice Essentials, It’s agents, subsidiaries, parent companies, and all contracted and affiliated entities are forever held harmless from any malpractice claim alleged to have been caused due to medical error or base upon the customer’s interpretation of the material they have reviewed, intentional or unintentional.  The Company is hereby released from any patient outcome, positive or negative, as a direct or indirect result of this educational experience.  

By checking the box to enable purchase, I acknowledge that payment for live programs, goods, services, and all purchased materials from Provider Practice Essentials, LLC cannot be made without my acceptance of all of these terms and conditions.  

The Customer acknowledges that purchases from the Company are not possible without the review and acceptance of these terms and conditions.

By checking the box to enable purchase, the Customer specifically accepts the below sections of the terms and conditions which are highlighted below for reiteration:

  1. 1)Room Reservation and Hotel Booking Policy
  2. 2)Rescheduling Policy
  3. 3)Refund Policy
  4. 4)Subscription and Online Membership Terms and Conditions
  5. 5)Cancellation Policy

By clicking acceptance of the terms and conditions and completing a purchase, the customer acknowledges that they have been given the opportunity to contact the Company for clarification of these terms prior to registering, and that they have chosen to register freely without question or objection to the terms herein.

The Advanced and Difficult Airway Course

The Ultrasound Course

The Clinical Skills & Procedure Workshop

The Clinical Skills & Procedure Workshop + The Airway Course

The Clinical Skills & Procedure Workshop + The Ultrasound Course

Dermatology Overview

Dermatology Essentials

Definition

Cellulitis: infection of dermis and subcutaneous fat

Impetigo: superficial purulent lesions, esp. on face and extremities. Commonly with bullae and/or golden crust

Erysipelas: raised erythematous lesion with clear borders

Folliculitis: hair follicle inflammation. Superficial and limited to the epidermis.

Furunculosis: hair follicle infection that extend to dermis. Multiple = carbuncle

Necrotizing Infection: Deeper SSTI that involve fascial and/or muscle compartments

Etiology

Microbiology

  • Cellulitis: primarily Staph and Strep, incl. MRSA. In immunocomp./diabetics, GNRs also
    • Other etiologies: cat/dog bite P. moltocida; gardening Sporothrix; salt water Vibrio vulnificus; puncture wound → Pseudomonas
  • Impetigo: Strep or Staph
  • Erysipelas: group A Strep usu.
  • Folliculitis/furunculosis: S. aureus, Pseudomonas
  • Necrotizing Infections: Polymicrobial (eg strep and GNRs in Type I, Fournier’s), Group A Strep, S. aureus, Aeromonas hydrophila, Vibrio vulnificus

At risk: athletic teams, military, prison, MSM, communities with MRSA infxn, Diabetic

High risk for more aggressive infection: splenectomy, immunocompromised

Differential Diagnosis

  • Cellulitis
  • Impetigo
  • Erysipelas
  • Folliculitis
  • Furunculosis
  • Necrotizing fasciitis
  • Myonecrosis
  • Calciphylaxis
  • Cutaneous metastasis from neoplasms (especially adenocarcinoma)
  • Graft-versus-host disease (in appropriate population)
  • Sweet syndrome

Patient History

  • Recent trauma to the affected area?
  • Any recent surgeries (hip replacement is risk factor)?
  • Ask about the presence of HIV, diabetes, liver disease, or kidney disease.
  • History of IV drug abuse or subcutaneous injection.
  • Recurrent Cellulitis: Assess for predisposing conditions such as edema, obesity, eczema, venous stasis, and toe web abnormalities.
  • Recurrent Abscesses: Search for local causes such as pilonidal cyst, HS, or foreign body. Consider 5-day decolonization (intranasal mupirosin, daily chlorhexidine). Consider neutrophil disorder if abscesses began in childhood.

Physical Exam

  • Evaluate affected area for erythema, edema, warmth, and pain on palpation.
  • Look for lymphangiitis (erythematous tracks under the skin marking an inflamed lymphatic system), palpate for lymphadenopathy.
  • Assess for evidence of necrotizing infection: systemic toxicity with high temperature, hypotension, disorientation, lethargy, skin discoloration or bullous lesions, anesthesia, firm skin with wooden-hard induration, pain extending beyond cutaneous erythema, pain out of proportion to exam

Work Up

Note: Diagnosis is largely clinical

Laboratory:

  • CBC with diff, ESR/CRP if concern for osteo, CK if concern for necrotizing infection or pyomyositis.
  • Furuncle/pustule can be aspirated for gram stain and culture.
  • For cellulitis, blood cultures are generally low yield, but should be obtained in patients undergoing chemo, neutropenic patients, and those who suffered animal bites.

Imaging:

  • If concern for osteo, xray; consider MRI
  • If concern for necrotizing infection can look for gas in fascial planes on x-ray or CT, but this is highly insensitive

Triage

More serious presentations of skin and soft tissue infections:

  • Toxic shock syndrome: fever, HA, vomiting, myalgias, pharyngitis, diarrhea, diffuse rash with desquamation. Hypotension and shock.
  • Osteomyelitis: infection of bone due to hematogenous seeding or direct spread from overlying focus.
  • Necrotizing fasciitis: infection and necrosis of superficial fascia, subq fat, and deep fascia. Clues: rapidly spreading cellulitis, systemic toxicity (inc TSS), pain out of proportion to exam, bullae formation, gangrene, crepitus. Surgical and medical emergency.
  • Gas gangrene: Clostridial myonecrosis, a fulminant skeletal muscle infection. C. perfringins usually in the setting of trauma; C. septicum in setting of cancer. Surgical and medical emergency.

Treatment

Purulent (furuncle/carbuncle/abscess):

  • Mild: I & D
  • Moderate: I & D, send for culture and sensitives
    • Empiric treatment: Bactrim 1-2 DS tab BID or Doxycycline 100mg BID
    • Defined treatment: MRSA: Bactrim 1-2 DS tab BID, MSSA: Dicloxacillin 250 Q6H or Cephalexin 500 Q6H or Cefadroxil 500mg po q12.
  • Severe: I & D, send for culture and sensitiivies
    • Empiric treatment: Vancomycin or Daptomycin or Linezolid or Ceftaroline
    • Defined treatment: MRSA: similar to empiric, MSSA: Nafcillin or Cefazolin or Clindamycin (if Susceptible)

Nonpurulent (necrotizing infection/cellulitis/erysipelas):

  • Mild: impetigo: topical mupirocin; oral treatment: Penicillin VK or Cephalosporin (eg Cephalexin 500mg PO Q6H) or Dicloxacillin 500mg PO Q6H or Clindamycin 300mg PO Q8H
  • Moderate: IV therapy: penicillin or Cefriaxone or Cefazolin or Clindamycin 300mg PO Q8H or 600mg IV Q8H
  • Severe: emergency surgical evaluation/debridement to rule out necrotizing process
    • Empiric treatment: Vancomycin PLUS Piperacillin/Tazobactam
    • Defined treatment for necrotizing infections:
      • Strep. pyogenes:Penicillin PLUS Clindamycin
      • Vibrio vulnificus:Doxycycline PLUS Ceftazidime
      • Aeromonas hydrophila:Doxycycline PLUS Ciprofloxacin
      • Polymicrobial: Vancomycin PLUS Piperacillin/Tazobactam

Duration of Therapy: 5-7 Days

Treatment Notes:

Erythema may initially worsen with antibiotics 2/2 local bacterial killing.

– For cellulitis, elevation of the affected extremity is essential to treatment.

– For Staph aureus infections (eg suppurative cellulitis) in 2014 at Hopkins susceptibilities were: TMP-SMX 87-88%, Tetracycline 89-91%, and Clindamycin 46-60%.

– For Beta-hemolytic Strep infections (eg non-suppurative cellulitis) all strains are susceptible to penicillin. At Hopkins there are high rates of resistance to TMP-SMX and tetracyclines and variable rates of resistance to Clindamycin.

– If you are concerned for a necrotizing infection, CONSULT SURGERY. Empiric antibiotic treatment with vancomycin (or linezolid) PLUS zosyn (or carbapenem) should be initiated. Clindamycin can be added to inhibit toxin production.

References

  1. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):e10-52. [PMID:24973422]
  2. Swartz MN. Clinical practice. Cellulitis. N Engl J Med. 2004;350(9):904-12. [PMID:14985488]

Resources

Heart Failure

Cardiology Essentials

Definition

Syndrome characterized by impaired myocardial performance and progressive maladaptive neurohormonal activation of the cardiovascular system leading to circulatory insufficiency to meet the body’s demands.

Systolic heart failure or heart failure with reduced ejection fraction (HFrEF): Clinical diagnosis of heart failure and an EF of less than 50%.

Diastolic heart failure or heart failure with preserved ejection fraction (HFpEF): Clinical signs and symptoms of heart failure with evidence of normal or preserved EF and evidence of abnormal LV diastolic function by Doppler echocardiography or cardiac catheterization

Right heart failure: Majority of cases are a result of left heart failure, although isolated pulmonary diseases can also cause this syndrome.

Etiology

  • Non-ischemic dilated cardiomyopathy (familial or idiopathic)
  • Hypertrophic cardiomyopathy
  • Restrictive cardiomyopathy
  • Cardiomyopathy as a result of fibroelastosis
  • Mitochondrial disease
  • Left ventricular non-compaction
  • Ischemic cardiomyopathy
  • Stress induced cardiomyopathy
  • Valvular obstruction or insufficiency
  • Hypertensive cardiomyopathy
  • Inflammatory (lymphocytic, eosinophilic, giant cell myocarditis)
  • Infectious (Chagas, Lyme disease, HIV, viral, bacterial, or fungal infections)
  • Endocrine disorders (thyroid disease, adrenal insufficiency, pheochromocytoma, acromegaly)
  • Familial storage disease (hemochromatosis, glycogen storage disease, Hurler syndrome, Anderson-Fabry disease)
  • Amyloidosis
  • Connective tissue disease (SLE, polyarteritis nodosa, scleroderma, myositis, sarcoidosis)
  • Muscular dystrophies
  • Neuromuscular disease (Friedreich ataxia, Noonan disease)
  • Toxins (alcohol, anthracyclines, radiation)
  • Tachyarrhythmia

Pathophysiology

Progressive disorder initiated by a form of myocardial injury either sudden (MI or myocarditis) or chronic insults (familial, metabolic, HTN, valve disease, shunting) that result in maladaptive compensatory mechanisms.

These mechanisms include activation of the sympathetic nervous system and activation of the RAS system which overtime lead to pump dysfunction and circulatory collapse.

Differential Diagnosis

Other entities that may look like acute decompensated heart failure:

  • Acute coronary syndrome
  • Interstitial lung disease
  • Pneumonia
  • ARDS
  • Other sources of volume overload such as CKD/ESRD vs cirrhosis, pulmonary hypertension, PE, cardiac tamponade, constrictive or restrictive pericarditis

Patient History

Ask about the signs and symptoms:

  • Worsening dyspnea at rest or exertion?
  • Fatigue?
  • Orthopnea?
  • PND?
  • Weight gain?
  • Increased edema?
  • Lightheadedness?
  • indigestion?
  • Chest heaviness?
  • Fever?
  • Chest pain?
  • Timing of symptom onset?

Ask about triggers of acute decompensation:

  • dietary indiscretion? foods high in Na like lunch meats, chips, canned foods, fast foods?
  • missed medication doses (diuretic)?
  • are they weighing themself daily? adjusting diuretics?
  • any signs or symptoms that an ischemic event has occurred?
  • do they consume alcohol excessively?

Physical Exam

  • Weight gain (if possible look at previous discharge weights)
  • Elevated jugular venous pulsations (Key!), hepatojugular reflux
  • Orthopnea
  • Pulmonary rales
  • Third and/or fourth heart sound
  • Pedal edema
  • Sacral edema in patients who are mostly in bed

Work Up

Laboratory

  • Renal function panel, liver function panel (CMP): Patients who are volume overloaded due to acute decompensated heart failure often have an acute kidney injury and hepatic congestion.
  • Potassium, calcium (CMP), magnesium. May need to check more frequently (e.g. bid) especially if pt will be diuresed.
  • CBC: Anemia is present in up to 40% of patient with heart failure.
  • Consider pro-BNP if volume exam not helpful; compare to prior.
  • If patient is presenting newly with HF and/or etiology is unclear:
    • troponin and lipid profile, especially if HFrEF the pt may need further work up for ischemic disease
    • TSH
    • in the right patient, consider iron studies (hemochromatosis), serum ceruloplasmin (Wilson’s), trypanosoma cruzi IgG (chagas), blood alcohol level or CDT etc.

Imaging

  • ECG, chest x-ray, echocardiography

Other imaging and diagnostic modalities that can be considered based on the patient’s history:

  • Cardiac MR
  • Nuclear imaging
  • Right heart catheterization
  • Left heart catheterization
  • CT angiogram.
  • Endomyocardial biopsy

 

Triage

Strongly consider step-down or ICU if evidence of decompensation with hypoperfusion (cold and wet):

Altered mental status, Cold extremities, evidence of organ hypoperfusion: increasing lactate or rising creatine, narrow pulse pressures

Risk Stratification

The American College of Cardiology/American Heart Association (ACC/AHA) Heart Failure Classification is a system used to classify heart failure into four stages based on the severity of symptoms and degree of functional impairment.

The four stages of heart failure in the ACC/AHA classification are:

  1. Stage A: At high risk of developing heart failure due to underlying conditions or risk factors such as hypertension, diabetes, or coronary artery disease.

  2. Stage B: Structural heart disease is present, but there are no symptoms of heart failure. This stage includes patients with a history of myocardial infarction (heart attack) or left ventricular remodeling after a cardiac injury.

  3. Stage C: Structural heart disease is present, and there are symptoms of heart failure such as fatigue, shortness of breath, and decreased exercise tolerance. This stage includes patients with past or current symptoms of heart failure who are responding to treatment.

  4. Stage D: Advanced heart failure that is refractory to standard treatments. This stage includes patients with severe symptoms of heart failure at rest, despite maximal medical therapy. Patients in this stage may require advanced interventions such as heart transplant or mechanical circulatory support.

The ACC/AHA Heart Failure Classification is based on a combination of factors, including clinical symptoms, physical examination findings, imaging studies, and laboratory tests. This classification system is useful for guiding treatment decisions and predicting outcomes in patients with heart failure. It can also help clinicians identify patients at high risk for developing heart failure and initiate preventive interventions to improve outcomes.

The New York Heart Association (NYHA) Functional Classification is a system used to classify heart failure into four stages based on the severity of symptoms and degree of functional impairment. The classification system was developed in 1928 and is still widely used today.

New York Heart Association functional classification

The NYHA Functional Classification is based on the patient’s subjective symptoms and limitations related to physical activity. It is often used in clinical practice to assess the severity of heart failure, guide treatment decisions, and predict outcomes. Patients with more severe symptoms are more likely to have poorer outcomes, and may require more aggressive treatment or consideration of advanced interventions, such as heart transplantation or mechanical circulatory support.

It’s important to note that the NYHA Functional Classification is just one aspect of the overall assessment of heart failure and should be used in conjunction with other clinical and diagnostic findings.

The Seattle Heart Failure Model (SHFM) is a clinical prediction model that provides an estimate of the probability of death and other adverse outcomes in patients with heart failure. It was developed to help clinicians make more informed decisions about treatment and to assist in risk stratification of patients with heart failure. The SHFM incorporates a wide range of patient characteristics, including demographics, clinical symptoms, laboratory values, and medication use, to predict the likelihood of various outcomes, such as mortality, hospitalization, and quality of life. The model is based on data from over 11,000 patients with heart failure and has been validated in several independent cohorts. To use the SHFM, a clinician inputs data on the patient’s age, sex, symptoms, medical history, laboratory values, and medication use into a web-based calculator. The model then generates a personalized estimate of the patient’s probability of death and other outcomes at 1 year and 5 years. The SHFM also provides a range of other information, such as the estimated survival time, probability of hospitalization, and predicted quality of life. The SHFM has been shown to have good accuracy in predicting outcomes in patients with heart failure, and it can be useful in guiding treatment decisions and in risk stratification of patients. However, it is important to note that the SHFM is just one tool among many that can be used in the management of heart failure, and it should be used in conjunction with clinical judgment and other diagnostic and prognostic tools.  

The MAGGIC (Meta-Analysis Global Group in Chronic Heart Failure) risk score is a prognostic model that is used to predict mortality in patients with chronic heart failure. It was developed using a large international database of over 39,000 patients with heart failure from 30 different studies.

The MAGGIC risk score takes into account a range of patient characteristics and clinical features that have been shown to be predictive of mortality in heart failure, including age, sex, systolic blood pressure, NYHA functional class, heart rate, serum sodium, serum creatinine, ejection fraction, etiology of heart failure, and use of certain medications such as ACE inhibitors, beta blockers, and diuretics.

The MAGGIC risk score assigns points to each of these variables based on their estimated contribution to mortality risk. The total number of points is then used to estimate the patient’s probability of mortality at 1 year and up to 5 years. The MAGGIC risk score has been shown to have good discrimination and calibration in predicting mortality in patients with heart failure.

The MAGGIC risk score is useful for identifying high-risk patients who may benefit from closer monitoring and more aggressive treatment, as well as for guiding clinical decision-making and communication with patients and families about prognosis. However, it is important to note that the MAGGIC risk score is just one tool among many that can be used in the management of heart failure, and it should be used in conjunction with clinical judgment and other diagnostic and prognostic tools.

CHA2DS2-VASc score: The CHA2DS2-VASc score is a tool used to estimate the risk of stroke in patients with atrial fibrillation. Since atrial fibrillation is a common comorbidity in heart failure, this score can be useful in managing heart failure patients with concurrent atrial fibrillation.

The CHA2DS2-VASc score is a clinical prediction rule that is primarily used to estimate the risk of stroke in patients with non-valvular atrial fibrillation. It is not specifically used in the management of heart failure, but rather in the management of comorbidities that may be present in patients with heart failure.

Patients with heart failure are at an increased risk of developing atrial fibrillation and other cardiovascular diseases, such as stroke, myocardial infarction, and peripheral vascular disease. As such, the CHA2DS2-VASc score can be used in the management of heart failure as a tool to identify patients who are at an increased risk of developing these conditions, and to guide clinical decision-making regarding the use of prophylactic therapies such as anticoagulation.

The CHA2DS2-VASc score takes into account a range of patient characteristics and clinical features that have been shown to be predictive of stroke and other cardiovascular events, including age, sex, history of stroke or transient ischemic attack, hypertension, diabetes, heart failure, and vascular disease. The score assigns points to each variable based on its estimated contribution to the risk of stroke or other cardiovascular events.

While the CHA2DS2-VASc score is not specifically designed for use in heart failure, it is an important tool that can be used to guide clinical decision-making in the management of patients with heart failure and comorbidities. It can help identify patients who may benefit from prophylactic therapies and other interventions aimed at reducing the risk of stroke and other cardiovascular events.

 

Heart failure with reduced ejection fraction (HFrEF) is a condition where the heart muscle weakens and can’t pump blood effectively. Treatment for HFrEF usually involves a combination of lifestyle changes, medication, and other interventions.

The HFrEF therapy calculator is a tool that can help healthcare professionals determine the most appropriate treatment plan for patients with HFrEF. The calculator takes into account the patient’s age, sex, blood pressure, kidney function, and other factors, and recommends medications and doses that have been shown to be effective in treating HFrEF.

The calculator is based on guidelines developed by the American College of Cardiology, American Heart Association, and Heart Failure Society of America. These guidelines recommend a combination of medications that target different aspects of heart failure, including angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), beta blockers, and aldosterone antagonists.

The HFrEF therapy calculator takes into account the patient’s current medications and adjusts the recommendations accordingly. It also provides guidance on when to start or stop certain medications, and how to titrate the doses to achieve the maximum benefit while minimizing side effects.

The Renal Risk Score is a tool that helps predict the risk of developing acute kidney injury in patients with heart failure who are undergoing intravenous diuretic therapy.

The renal risk score is a tool that is primarily used to estimate a patient’s risk of developing acute kidney injury (AKI) after undergoing cardiac surgery. However, the risk of AKI is also a concern in patients with heart failure, particularly those who are hospitalized or receiving treatment with certain medications.

In patients with heart failure, the risk of AKI is often related to factors such as low cardiac output, fluid overload, and the use of medications that can affect kidney function. Some of these medications include diuretics, angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers (ARBs), and nonsteroidal anti-inflammatory drugs (NSAIDs).

Several studies have looked at the use of the renal risk score in patients with heart failure. One study, published in the journal Circulation Heart Failure in 2014, found that the renal risk score was able to predict the risk of AKI in patients hospitalized with heart failure. The study also found that patients with higher renal risk scores were more likely to require dialysis or have a longer hospital stay.

Another study, published in the Journal of Cardiac Failure in 2018, evaluated the use of the renal risk score in patients with heart failure who were receiving treatment with sacubitril/valsartan, a medication used to treat heart failure with reduced ejection fraction. The study found that the renal risk score was able to predict the risk of AKI in these patients and could be used to guide dosing of the medication to minimize the risk of kidney injury.

Overall, while the renal risk score was developed for use in patients undergoing cardiac surgery, it may also be a useful tool for predicting the risk of AKI in patients with heart failure. By identifying patients at higher risk of AKI, healthcare providers can take steps to minimize the risk of kidney injury and improve outcomes for these patients.

Treatment

Acute Decompensated Heart Failure

IV diuresis:

Determine home regimen and try to give an increased dose. Patients with anasarca DO NOT ABSORB ORAL MEDS. Remember patients who are naïve to diuretics may not require high doses for good urine output. As a rule of thumb, the furosemide dose can be initially calculated at 40 (mg) X serum creatinine. Titration will be performed according to initial response. Common diuretics include furosemide, torsemide, metolazone, and Chlorothiazide. For ESRD patients who no longer make urine, volume removal will be via ultrafiltration and may need to be done more aggressively as tolerated by BP. Be sure to check electrolytes twice a day and aggressively supplement (keep K around 4 and magnesium around 2.4. Check daily weights (standing if possible) and monitor Ins and Outs.

Afterload reduction in systolic heart failure:

If no kidney injury is detected you can consider an ACE-Inhibitor, otherwise hydralazine with/or without nitrates. In more severe cases, one may consider sodium nitroprusside

Inotropy: Usually in severe cases or if effective diuresis is not achieved despite other efforts.

Dobutamine or milrinone

Remember to hold beta blockers in acute decompensated heart failure

Chronic Heart Failure Therapies

Mortality reducing agents:

  • ACE inhibitors/ARBs
    • start in all pt’s with current or prior sx’s of HFrEF unless contraindicated; try ACEi first and then try ARB if not tolerated
    • caution in pts with ↓SBP, renal insufficiency, or ↑serum potassium (>5.0 mEq/L). Angioedema occurs in < 1% of pts with ACE inhibitors.
  • ANRIs (angiotensin receptor–neprilysin inhibitor: valsartan/sacubitril)
    • start in pt’s with NYHA class II-III HFrEF who tolerate an ACE inhibitor or ARB, replacement by an ARNI is recommended to further reduce morbidity and mortality. Harmful if started concomitantly with ACEi/ARB – wait 36 hrs after stopping ACEi/ARB to inititate
  • Beta blockers (metoprolol succinate, bisoprolol, and carvedilol)
    • start in all pt’s with current or prior sx’s of HFrEF unless contraindicated
  • ISDN + Hydralazine
    • clear benifit in African American pt’s with NYHA class III-IV HFrEF
    • likely beneficial for all pt’s with HFrEF, though utility somewhat limited by TID dosing
  • Aldosterone receptor blockers (eplerenone, spironolactone)
    • recommended in patients with NYHA class II–IV HF and who have LVEF of 35% or less

HF Hospitalization Reducing Agents

  • Digoxin
  • Ivabradine (inhibits the If current in the SA node, ↓HR)
    • can use in NYHA class II-III stable chronic HFrEF (LVEF ≤35%) who tolerate maximum BB in NSR with HR of 70 bpm or more at rest[2]

Advanced Therapies

  • Left ventricular assist device (right heart must be able to tolerate this)
  • Heart transplantation

References

  1. Khot UN, Jia G, Moliterno DJ, et al. Prognostic importance of physical examination for heart failure in non-ST-elevation acute coronary syndromes: the enduring value of Killip classification. JAMA. 2003;290(16):2174-81. [PMID:14570953]
  2. Yancy CW, et al: 2016 ACC/AHA/HFSA Focused Update on NewPharmacological Therapy for Heart Failure: An Update of the 2013 ACCF/AHA Guideline for theManagement of Heart Failure, Journal of the American College of Cardiology (2016), doi: 10.1016/j.jacc.2016.05.011.
  3. Griffin BP, Callahan TD, Menon V, et al. Manual of Cardiovascular Medicine. Lippincott Williams & Wilkins. 2013 4th edition; Heart Failure and Transplant 125-159
  4. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147-239. [PMID:23747642]

Resources

Advanced and Difficult Airway Course Content

Airway Anatomy and Assessment

  • Overview of airway anatomy
  • Indications of normal airway
  • Identification of difficult airway characteristics
  • Application of assessment for anticipation

Indications for Airway Management

  • Predictors of airway failure
  • Identification of clinical risk factors
  • When to intervene

Non-Invasive Airway Interventions

  • Progressive Oxygenation
  • Pulmonary Mechanics
  • Measured oxygenation techniques
  • CPAP and BIPAP

Invasive Airway Management

  • Rescue airway interventions
  • Laryngeal mask airway
  • Posterior pharyngeal airway adjuncts
  • Endotracheal intubation

Airway Options

  • Identification and selection of the correct airway device
  • Discussion of equipment options and their uses
  • Preparation for induction and intubation

Intubation Drugs

  • A pharmacology review of induction agents
  • Selection of the best drug combinations for induction
  • Safe decision-making

Induction and Intubation

  • Application of each prior learning topic to provide safe intubation
  • Stepwise, thorough discussion about safe airway induction and intubation
  • Correct techniques for endotracheal tube insertion

Confirming Tube Placement

  • Processes to ensure an endotracheal tube is correctly placed
  • Discussion about reintubation and confirmation
  • Application to difficult airway management

Difficult Airway Equipment

  • Intubating LMA, Lighted Stylet, Light Wand, Video Laryngoscope and more
  • Learn how to select the correct equipment for the situation
  • Double set-up indications

The Difficult Airway 

  • Application of difficult airway algorithms to fit the correct clinical conditions
  • A stepwise process discussion to maximize airway success
  • Indications and procedure for emergent cricothyrotomy

Ultrasound Course Content

Introduction to Ultrasound

  • Ultrasound Physics
  • Probe functions and types
  • Methods of scanning (sliding, rocking, other movements and techniques)
  • Probe Settings (depth, “knobology”)
  • Hand movements and dexterity

Biliary Ultrasound

  • Liver and Gall Bladder
  • Identification of anatomy
  • Abnormal Findings and Diagnostic Criteria
  • Interpretation of findings and Management

DVT Ultrasound

  • Lower extremity venous anatomy and scanning technique
  • Expected normal and abnormal findings
  • Interpretation of doppler and compressibility images
  • Clinical decision-making and follow-up

eFAST Ultrasound

  • Trauma-focused exam 
  • Includes abdomen, bladder, cardiac, and pulmonary imaging
  • Diagnostic criteria and decision-making
  • Includes common and subtle findings

Ocular Ultrasound

  • Technique and probe placement
  • Retinal detachment, foreign bodies, lens dislocation, vitreous hemorrhage, retrobulbar hematoma, and papilledema
  • Next clinical steps

Pelvic Ultrasound

  • Probe placement and scanning technique
  • Uterine, ovarian, and adnexal pathology
  • Next clinical steps

Pulmonary Ultrasound

  • Small groups, team led with hands-on guidance and findings
  • Review and individual practice sessions with instructors
  • Additional ultrasound applications
  • Wrap-Up and Closing

Renal Ultrasound

  • Anatomy and probe placement
  • Ultrasonic anatomy and expected findings
  • Clinical correlation and management

Soft Tissue Ultrasound

  • Probe selection and settings
  • Foreign body, cellulitis, abscess, and cyst identification
  • Next clinical steps

Ultrasound for Vascular Access

  • Anatomy of peripheral and central veins
  • Application of Ultrasound to assist with line placement
  • Visualization of landmarks and expected clinical findings

Abdominal Aorta Ultrasound

  • Anatomy and ultrasound placement
  • Expected normal and abnormal findings
  • Next clinical steps and application

3-Day Clinical Skills & Procedure Workshop + The Airway Course

Day 1 Morning

Airway Anatomy and Assessment

  • How to assess an airway
  • Identification of landmarks
  • Predicting a difficult airway
  • Special scenarios
  • Airway classification and grading

Indications for Airway Management

  • Clinical conditions
  • Respiratory status
  • Anatomy
  • Predictors of airway need
  • Common approaches

Non-Invasive and Invasive Airway Management

  • Escalation of intervention
  • Sequential oxygenation
  • BIPAP
  • CPAP
  • Endotracheal Intubation
  • Airway Adjuncts (LMA, OPA)

Airway Options and Medications

  • Types of airway devices
  • Airway equipment
  • Laryngoscopes
  • Fiberoptic and Video Scopes
  • Induction agents and dosing

Induction and Intubation

  • Procedure organization and setup
  • Stepwise airway protocols
  • Anatomy
  • Endotracheal Intubation
  • Hands-On Procedure Practice

Tube Confirmation and Difficult Airway Management

  • Confirmatory tests
  • Defining an intact airway
  • How to manage a failed airway
  • Difficult airway algorithm and management
  • Fiberoptic laryngoscopy
  • Laryngeal mask airway
  • Video laryngoscope

Day 1 Afternoon

procedure

Difficult Airway Algorithm and Simulation

  • Application of the difficult airway algorithm
  • Simulated patient scenarios
  • Intubation with video laryngoscopy
  • Hands-On airway procedure lab
  • Individual review with instructor
  • Certification Examination

Day 2 Morning

Cardiac

Cardiac Disorders

  • Course Introduction
  • Cardiac Overview
  • EKG Interpretation
  • Acute MI (recognition, management)
  • Common Dysrhythmias
  • Electrolyte Abnormalities and rhythm impacts
  • Condition blocks
  • Bundle Branch Blocks
  • Application to practice
Pulmonary

Pulmonary Disorders

  • Pulmonary Overview
  • Basic Airway Assessment
  • Pneumothorax
  • Asthma Management
  • COPD Management
  • Supplemental Oxygenation
  • Wells Criteria
  • PERC Rule
  • Using D-Dimer
  • Pulmonary Embolism
  • Treatment of Pulmonary Embolism

Introduction to Radiology – Chest and Abdomen

 
  • Overview of Radiograph Interpretation
  • Chest, Shoulder, Clavicle Radiographs
  • Systemic Reading Process
  • Abnormal Radiographs
  • Radiographic Signs of Major Diseases
  • Suggested treatment guidelines based on findings
  • Radiographic Signs of High Impact Injuries
  • Foreign body ingestion, aspiration, and insertion
  • Pediatric foreign body aspiration and management

Day 2 Afternoon

procedure

Procedure Overview

  • Procedural Overview
  • Needle Decompression
  • Chest Tube Insertion
  • Tracheostomy Replacement
  • Shoulder Reduction and Immobilization
  • Upper Extremity Joint Aspiration
  • Trigger Point Injection
  • Nail Trephination
  • Nail Removal
  • Foreign Body and Fish Hook Removal
    Introduction to Suture Techniques
     
suturing

The Suturing Course

  • Suture Clinic and Equipment Introduction
  • Knot Tying
  • Simple Interrupted
  • Simple Running
  • Mattress
  • Subcutaneous/Multiple Layer Closure
  • Staples
  • Skin Adhesive
  • Surgeon’s Knot
  • Buried Knot
  • Billing and Documentation for Sutures
  • Local Injections and Digital Blocks
 
procedure

Procedure Workshop

  • Knee Injection and Aspiration
  • Shoulder Injection
  • Needle Decompression
  • Chest Tube Insertion

Day 3 Morning

Cervical Spine Injuries

  • Long Board and Collar Removal
  • NEXUS Criteria
  • Unstable Fractures
  • Mechanisms of Common Fractures
  • Immobilization
  • Ordering the Correct Studies
  • Correct Consult and Referral
 

Thoracic and Lumbar Spine Injuries

  • Spine form and function
  • Mechanisms of Injury
  • Unstable Fractures
  • Mechanisms of Common Fractures
  • Cauda Equina Syndrome
  • Epidural Abscess
  • Ordering the Correct Studies
  • Correct Consult and Referral
 
Extremity

Upper and Lower Extremity Injuries

  • Speaking Orthopedics
  • Common Patterns of Fractures
  • Common Dislocation and Reduction Techniques
  • Splinting Techniques and Compartment Syndrome
  • Clavicle, Shoulder, Humerus, Elbow, Radius. Ulna. Paired fractures, Wrist and Carpal Bones, Hand
  • Amputations
  • When to Consult Orthopedics
  • When to Consider Transfer/EMS
  • What to send home

Day 3 Afternoon

skin

Skin Conditions Not to Miss

  • Skin and Soft Tissue Conditions
  • Emergent Rash Identification
  • Cellulitis
  • Abscess Incision and Drainage
  • DVT Identification and Decisions Rules
  • Burn Care and Referral Criteria
  • What Not to Send Home
procedure

Procedure Workshop

  • Procedure Clinic
  • Lumbar Puncture
  • Splinting Workshop
  • Intraosseous Access
  • Central Venous Catheter Insertion

3-Day Clinical Skills & Procedure Workshop + The Ultrasound Course

Day 1 Morning

Introduction to Ultrasound

  • Ultrasound Physics
  • Probe functions and types
  • Methods of scanning (sliding, rocking, other movements and techniques)
  • Probe Settings (depth, “knobology”)
  • Hand movements and dexterity
ultrasound

Abdominal Ultrasound

  • Aorta (all views, normal anatomy, pathology)
  • Biliary Quadrant (gallbladder, stones, techniques)
  • Kidney (hydronephrosis, pyelonephritis)
  • Trans-abdominal Pelvis
procedure

Trauma Ultrasound

  • eFAST exam
  • Right upper quadrant imaging
  • Left upper quadrant imaging
  • Bladder Imaging
  • Cardiac Imaging
  • Lung Imaging
procedure

Free Scan with Live Models

  • Small groups, team led with hands-on guidance and findings

Day 1 Afternoon

Specialty Ultrasound

  • Ocular Ultrasound (retinal detachment, foreign bodies)
  • Foreign body imaging
  • Ultrasound-Guided IV and Central access technique
  • Lower Extremity Vascular Ultrasound
procedure

Afternoon Free Scan

  • Small groups, team led with hands-on guidance and findings
  • Review and individual practice sessions with instructors
  • Additional ultrasound applications
  • Wrap-Up and Closing

Day 2 Morning

Cardiac

Cardiac Disorders

  • Course Introduction
  • Cardiac Overview
  • EKG Interpretation
  • Acute MI (recognition, management)
  • Common Dysrhythmias
  • Electrolyte Abnormalities and rhythm impacts
  • Condition blocks
  • Bundle Branch Blocks
  • Application to practice
Pulmonary

Pulmonary Disorders

  • Pulmonary Overview
  • Basic Airway Assessment
  • Pneumothorax
  • Asthma Management
  • COPD Management
  • Supplemental Oxygenation
  • Wells Criteria
  • PERC Rule
  • Using D-Dimer
  • Pulmonary Embolism
  • Treatment of Pulmonary Embolism

Introduction to Radiology – Chest and Abdomen

 
  • Overview of Radiograph Interpretation
  • Chest, Shoulder, Clavicle Radiographs
  • Systemic Reading Process
  • Abnormal Radiographs
  • Radiographic Signs of Major Diseases
  • Suggested treatment guidelines based on findings
  • Radiographic Signs of High Impact Injuries
  • Foreign body ingestion, aspiration, and insertion
  • Pediatric foreign body aspiration and management

Day 2 Afternoon

procedure

Procedure Overview

  • Procedural Overview
  • Needle Decompression
  • Chest Tube Insertion
  • Tracheostomy Replacement
  • Shoulder Reduction and Immobilization
  • Upper Extremity Joint Aspiration
  • Trigger Point Injection
  • Nail Trephination
  • Nail Removal
  • Foreign Body and Fish Hook Removal
    Introduction to Suture Techniques
     
suturing

The Suturing Course

  • Suture Clinic and Equipment Introduction
  • Knot Tying
  • Simple Interrupted
  • Simple Running
  • Mattress
  • Subcutaneous/Multiple Layer Closure
  • Staples
  • Skin Adhesive
  • Surgeon’s Knot
  • Buried Knot
  • Billing and Documentation for Sutures
  • Local Injections and Digital Blocks
 
procedure

Procedure Workshop

  • Knee Injection and Aspiration
  • Shoulder Injection
  • Needle Decompression
  • Chest Tube Insertion

Day 3 Morning

Cervical Spine Injuries

  • Long Board and Collar Removal
  • NEXUS Criteria
  • Unstable Fractures
  • Mechanisms of Common Fractures
  • Immobilization
  • Ordering the Correct Studies
  • Correct Consult and Referral
 

Thoracic and Lumbar Spine Injuries

  • Spine form and function
  • Mechanisms of Injury
  • Unstable Fractures
  • Mechanisms of Common Fractures
  • Cauda Equina Syndrome
  • Epidural Abscess
  • Ordering the Correct Studies
  • Correct Consult and Referral
 
Extremity

Upper and Lower Extremity Injuries

  • Speaking Orthopedics
  • Common Patterns of Fractures
  • Common Dislocation and Reduction Techniques
  • Splinting Techniques and Compartment Syndrome
  • Clavicle, Shoulder, Humerus, Elbow, Radius. Ulna. Paired fractures, Wrist and Carpal Bones, Hand
  • Amputations
  • When to Consult Orthopedics
  • When to Consider Transfer/EMS
  • What to send home

Day 3 Afternoon

skin

Skin Conditions Not to Miss

  • Skin and Soft Tissue Conditions
  • Emergent Rash Identification
  • Cellulitis
  • Abscess Incision and Drainage
  • DVT Identification and Decisions Rules
  • Burn Care and Referral Criteria
  • What Not to Send Home
procedure

Procedure Workshop

  • Procedure Clinic
  • Lumbar Puncture
  • Splinting Workshop
  • Intraosseous Access
  • Central Venous Catheter Insertion

1-Day Advanced and Difficult Airway Course Schedule

Day 1 Morning

Airway Anatomy and Assessment

  • How to assess an airway
  • Identification of landmarks
  • Predicting a difficult airway
  • Special scenarios
  • Airway classification and grading

Indications for Airway Management

  • Clinical conditions
  • Respiratory status
  • Anatomy
  • Predictors of airway need
  • Common approaches

Non-Invasive and Invasive Airway Management

  • Escalation of intervention
  • Sequential oxygenation
  • BIPAP
  • CPAP
  • Endotracheal Intubation
  • Airway Adjuncts (LMA, OPA)

Airway Options and Medications

  • Types of airway devices
  • Airway equipment
  • Laryngoscopes
  • Fiberoptic and Video Scopes
  • Induction agents and dosing

Induction and Intubation

  • Procedure organization and setup
  • Stepwise airway protocols
  • Anatomy
  • Endotracheal Intubation
  • Hands-On Procedure Practice

Tube Confirmation and Difficult Airway Management

  • Confirmatory tests
  • Defining an intact airway
  • How to manage a failed airway
  • Difficult airway algorithm and management
  • Fiberoptic laryngoscopy
  • Laryngeal mask airway
  • Video laryngoscope

Day 1 Afternoon

procedure

Difficult Airway Algorithm and Simulation

  • Application of the difficult airway algorithm
  • Simulated patient scenarios
  • Intubation with video laryngoscopy
  • Hands-On airway procedure lab
  • Individual review with instructor
  • Certification Examination

1-Day Ultrasound Course Schedule

Day 1 Morning

Introduction to Ultrasound

  • Ultrasound Physics
  • Probe functions and types
  • Methods of scanning (sliding, rocking, other movements and techniques)
  • Probe Settings (depth, “knobology”)
  • Hand movements and dexterity
ultrasound

Abdominal Ultrasound

  • Aorta (all views, normal anatomy, pathology)
  • Biliary Quadrant (gallbladder, stones, techniques)
  • Kidney (hydronephrosis, pyelonephritis)
  • Trans-abdominal Pelvis
procedure

Trauma Ultrasound

  • eFAST exam
  • Right upper quadrant imaging
  • Left upper quadrant imaging
  • Bladder Imaging
  • Cardiac Imaging
  • Lung Imaging
procedure

Free Scan with Live Models

  • Small groups, team led with hands-on guidance and findings

Day 1 Afternoon

Specialty Ultrasound

  • Ocular Ultrasound (retinal detachment, foreign bodies)
  • Foreign body imaging
  • Ultrasound-Guided IV and Central access technique
  • Lower Extremity Vascular Ultrasound
procedure

Afternoon Free Scan

  • Small groups, team led with hands-on guidance and findings
  • Review and individual practice sessions with instructors
  • Additional ultrasound applications
  • Wrap-Up and Closing

The APP Clinical Skills and Procedure Workshop Schedule

Day 1 Morning

Cardiac

Cardiac Disorders

  • Course Introduction
  • Cardiac Overview
  • EKG Interpretation
  • Acute MI (recognition, management)
  • Common Dysrhythmias
  • Electrolyte Abnormalities and rhythm impacts
  • Condition blocks
  • Bundle Branch Blocks
  • Application to practice
Pulmonary

Pulmonary Disorders

  • Pulmonary Overview
  • Basic Airway Assessment
  • Pneumothorax
  • Asthma Management
  • COPD Management
  • Supplemental Oxygenation
  • Wells Criteria
  • PERC Rule
  • Using D-Dimer
  • Pulmonary Embolism
  • Treatment of Pulmonary Embolism

Introduction to Radiology – Chest and Abdomen

 
  • Overview of Radiograph Interpretation
  • Chest, Shoulder, Clavicle Radiographs
  • Systemic Reading Process
  • Abnormal Radiographs
  • Radiographic Signs of Major Diseases
  • Suggested treatment guidelines based on findings
  • Radiographic Signs of High Impact Injuries
  • Foreign body ingestion, aspiration, and insertion
  • Pediatric foreign body aspiration and management

Day 1 Afternoon

procedure

Procedure Overview

  • Procedural Overview
  • Needle Decompression
  • Chest Tube Insertion
  • Tracheostomy Replacement
  • Shoulder Reduction and Immobilization
  • Upper Extremity Joint Aspiration
  • Trigger Point Injection
  • Nail Trephination
  • Nail Removal
  • Foreign Body and Fish Hook Removal
    Introduction to Suture Techniques
     
suturing

The Suturing Course

  • Suture Clinic and Equipment Introduction
  • Knot Tying
  • Simple Interrupted
  • Simple Running
  • Mattress
  • Subcutaneous/Multiple Layer Closure
  • Staples
  • Skin Adhesive
  • Surgeon’s Knot
  • Buried Knot
  • Billing and Documentation for Sutures
  • Local Injections and Digital Blocks
 
procedure

Procedure Workshop

  • Knee Injection and Aspiration
  • Shoulder Injection
  • Needle Decompression
  • Chest Tube Insertion

Day 2 Morning

Cervical Spine Injuries

  • Long Board and Collar Removal
  • NEXUS Criteria
  • Unstable Fractures
  • Mechanisms of Common Fractures
  • Immobilization
  • Ordering the Correct Studies
  • Correct Consult and Referral
 

Thoracic and Lumbar Spine Injuries

  • Spine form and function
  • Mechanisms of Injury
  • Unstable Fractures
  • Mechanisms of Common Fractures
  • Cauda Equina Syndrome
  • Epidural Abscess
  • Ordering the Correct Studies
  • Correct Consult and Referral
 
Extremity

Upper and Lower Extremity Injuries

  • Speaking Orthopedics
  • Common Patterns of Fractures
  • Common Dislocation and Reduction Techniques
  • Splinting Techniques and Compartment Syndrome
  • Clavicle, Shoulder, Humerus, Elbow, Radius. Ulna. Paired fractures, Wrist and Carpal Bones, Hand
  • Amputations
  • When to Consult Orthopedics
  • When to Consider Transfer/EMS
  • What to send home

Day 2 Afternoon

skin

Skin Conditions Not to Miss

  • Skin and Soft Tissue Conditions
  • Emergent Rash Identification
  • Cellulitis
  • Abscess Incision and Drainage
  • DVT Identification and Decisions Rules
  • Burn Care and Referral Criteria
  • What Not to Send Home
procedure

Procedure Workshop

  • Procedure Clinic
  • Lumbar Puncture
  • Splinting Workshop
  • Intraosseous Access
  • Central Venous Catheter Insertion

The Clinical Skills & Procedure Workshop + The Ultrasound Course

JULY 4 SAVINGS!

Celebrate Independence day with us!

All of our LIVE Programs through October have been marked down 20%!

PLUS

Use Code FREEDOM23

and take 10% off ALL ONLINE PRODUCTS (Including our 4-day virtual conference)

ACT NOW!

Offer Expires July 7. Excludes hotels and custom group programs.