Sharpening Clinical Judgment

Credit

Speaker

Paul Langlois, APN, PhD, CCRN, CCNS Related seminars and products

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Paul Langlois, APN, PhD, CCRN, CCNS, is a critical care clinical specialist in the surgical, medical, neurologic, burn, CCU, and trauma ICUs of Cook County Hospital, Chicago. Drawing on over 40 years of experience assessing and managing patients with life-threatening diseases, Dr. Langlois provides advanced-level training to nurses, nurse practitioners, physician assistants, respiratory therapists, and physicians.

Dr. Langlois is committed to providing the highest quality of care to patients through advanced education. His presentations are evidence-based, timely, and go beyond content review to sharpen the clinical reasoning underneath it, using illness scripts, anticipatory thinking, and layered case studies to help experienced clinicians reason out loud rather than simply recall answers. As a bedside clinical nurse specialist, he has developed several institution-wide protocols for the multidisciplinary assessment and management of patients.

His presentations are enthusiastically delivered and offer highly practical tips that help make the most challenging concepts easy to understand, from cognitive-bias traps that shape a shift to the SBAR calibration that gets a "come now" call heard the first time. Linking knowledge to clinical practice is the goal of every educational program, and Dr. Langlois builds that link through near-miss scenarios and "what would you do?" cases designed to sharpen judgment, not just test it.

 

Speaker Disclosures:
Financial: Dr. Paul Langlois has employment relationship with Cook County Hospital and Emergency Care Consultants. He receives a speaking honorarium and recording royalties from PESI, Inc. He has no relevant financial relationships with ineligible organizations.
Non-financial: Dr. Paul Langlois is a member of the American Nurses Association, the American Association of Critical Care Nurses, and the Society of Critical Care Medicine.

Additional Info

You will have access for 90 days after the program for review. For live CE credit, you must watch the live webcast in its entirety at its scheduled time and complete the CE quiz and evaluation within one week. Please note that this requirement may vary by credit type. Please see detailed credit information for specific requirements for each credit type.

Please note: There will be a 70-minute lunch and two 15-minute breaks; one in the morning and one in the afternoon. Lunch and break times will be announced by the speaker and at their discretion. A more detailed schedule is available upon request.

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Objectives

1. Analyze the components of a rapid, focused physical assessment to prioritize findings that change the plan of care.
2. Differentiate the clinical, ECG, and biomarker criteria used to diagnose acute myocardial infarction from other causes of chest pain.
3. Justify medication selection for heart failure based on HFrEF versus HFpEF presentation and hemodynamic status.
4. Differentiate the heart sounds and physical findings of pericarditis from those of acute myocardial infarction.
5. Contrast the pharmacologic management of asthma with that of COPD, including indications for escalation to surgical intervention.
6. Differentiate chest radiograph and clinical findings of pneumothorax from pneumonia to guide urgent versus routine intervention.
7. Evaluate blood pressure management strategies for hypertensive emergencies in ischemic versus hemorrhagic stroke.
8. Categorize seizure types by clinical presentation and EEG findings to guide rescue versus maintenance therapy selection.
9. Analyze the physical assessment findings and complications associated with bowel perforation to anticipate clinical deterioration.
10. Evaluate the risks and benefits of current anti-obesity pharmacotherapy, including GLP-1 receptor agonists, per 2026 guidance.
11. Compare treatment modalities for renal stones based on stone characteristics and patient presentation.
12. Differentiate the physical assessment findings of Ebola and Hantavirus infection to guide early recognition and isolation precautions.
13. Summarize the 2026 updates to dyslipidemia management guidelines, including LDL-C targets, coronary artery calcium scoring, and lipoprotein(a).
14. Apply illness-script and anticipatory-thinking frameworks to distinguish early sepsis from cardiogenic shock and anticipate clinical trajectory.
15. Formulate a prioritization strategy for multiple deteriorating patients, incorporating SBAR communication calibrated to clinical urgency.

Outline

Think Like the Nurse Who’s Seen It All

• Illness Scripts, Side by Side: Early sepsis vs cardiogenic shock – same instability, different story
• “Something’s Wrong, But I Can’t Name It”: Turing gut instinct into data the provider can act on
• Anticipatory Thinking: Your patient from hour 4 to hour 8? Indications a problem is brewing
• Cognitive Bias Bootcamp: Whiteboard diagnosis influence; trust the monitor vs the patient in front of you

Prioritization Under Fire

• A Full Patient Assignment: Decide what can wait 20 minutes and what can’t in real time
• SBAR Recalibrated: A “heads up” call vs. a “come now” call – and how the provider hears the distinction

Cardiac Crisis: An Unfolding Case Series

Myocardial Infarction

• 12-lead pearls, cardiac catheterization lab interventions, medication logic
• Near-miss case: The troponin written off as demand ischemia – until it wasn’t

Heart Failure

• HFrEF vs. HFpEF presentation and treatment divergence
• Mechanical support: Impella, intra-aortic balloon pump, VADs
• Diuretic / ACE-ARB / nitrate decision-making
• Complex challenge cases: The HFpEF patient whose numbers look reassuring – until the aren’t

VTE & Pulmonary Embolism

• Near-miss case: The “anxiety attack” that was a PE
• Catheter-directed thrombolysis, IVC filters, mechanical thrombectomy vs. DOACs

Pericarditis

• Heart sounds (audio) and physical findings that separate it from an MI
• NSAIDs, colchicine, IL-1 blockers – when each earns its place
• What Would You Do? scenario: Chest pain … is the dx pericarditis or something more dangerous?

Respiratory Curveballs

Asthma & COPD

• Spirometry interpretation, pharmacologic escalation, surgical options (bullectomy, transplant)
• Lung sounds audio library for pattern recognition, not memorization
• Complex challenge case: The COPD patient not weaning off oxygen the way the algorithm predicts

Pneumothorax & Foreign Body Airway Obstruction

• Chest tube management and cricothyroidotomy – visual technique demonstration
• What Would You Do? scenario: Sudden decompensation with an airway you can’t fully assess

Pneumonia

• Bacterial vs. viral vs. fungal: Reasoning to the right empiric call, not just naming the drug
• Near-miss case: The “pneumonia” that didn’t respond to antibiotics because it wasn’t pneumonia

Neuro Emergencies: Recognizing, Prioritize, Act

Stroke

• Ischemic vs. hemorrhagic, 2026 guideline updates, clipping/coiling/embolization, BP targets
• Complex challenge case: The stroke mimic that almost received tPA

Seizures

• Type and presentation recognition: rescue (benzodiazepines) vs. maintenance therapy
• What Would You Do? scenario: Status epilepticus not responding to first-line rescue med

Meningitis

• Reading the LP: Gram stain, PCR, cell count – and how each one changes the pharmacy call
• Near-miss case: The stiff neck written off as a muscle strain

Spinal Cord Injury

• Assessment, immobilization, decompression, rehab, and stem cell treatment updates
• Complex challenge case: A trauma spinal injury masked by something more obvious and painful

GI & Renal: Reading the Trend, Not the Number

GI Bleed

• Endoscopic interventions, PPI/vasoactive/antibiotic logic, transfusion thresholds
• Near-miss case: The “hemorrhoid bleed” that was actually a brisk upper GI bleed

Bowel Perforation

• Complications (peritonitis, sepsis, abscess) and the fluid/antibiotic race against them
• What Would You Do? scenario: Vague abdominal pain that quietly turns septic

Obesity/Pharmacotherapy

• Tirzepatide, semaglutide, orforglipron – and the 2026 WHO guidance shaping their use
• Complex challenge case: GLP-1 side effects mimicking a surgical abdomen

Acute Kidney Injury

• Hemodialysis vs. peritoneal vs. CRRT: Which one, and the reasoning behind the choice
• What Would You Do? scenario: Dialysis modality decision with time pressure and conflicting labs

Renal Stones & Pyelonephritis

• Testing pathways and treatment decisions, inpatient and out 
• Near-miss case: The “kidney stone” pain that was actually a ruptured AAA

Infectious Disease: Old Threats, New Twists

Emerging Threats

• Ebola, Hantavirus, M-Pox: Recognition and treatment when these aren’t top-of-mind
• What Would You Do? scenario: A returning traveler with a differential that includes a rare and deadly cause

Enduring Threats

• TB, COVID, influenza: Current pharmacologic treatment and immunization guidance
• Complex challenge case: The “flu” that turned out to be something else entirely.

Medication as Assessment

• What the antimicrobial choice of the MAR tells you about the clinical picture underneath it

Guideline Updates You Need to Know

• Dyslipidemia Management: New LDL-C targets, coronary artery calcium score, lipoprotein(a)
• Sepsis & Septic Shock: A case presentation on screening, fluid selection, vasopressor sequencing, transfusion strategy
• Pediatric Stroke Guideline Updates: Recognition and symptoms in kids; endovascular intervention; first time seizures
• VTE/PE Treatment Shifts: DOAC vs. thrombolytic decision points and updated catheter-directed therapy criteria
• Transfusion Threshold Updates: Restrictive vs. liberal strategies for GI bleed and critical illness

Target Audience

This program is designed exclusively for RNs across the full spectrum of acute and specialty care – from med-surg, critical care, and the ED to cardiac, neuro, and geriatric units. Whether you’re at the bedside, charge nurse, rapid response, or precepting the next generation, this course sharpens the clinical judgment every RN relies on.