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1. Recognize the cellular alterations that occur during shock
2. Discriminate how cardiac output differs among the five shock states
3. Determine three causes of cardiogenic shock Could you advance this statement? Using
4. Contrast the fluids used in resuscitation of the patient in hypovolemic shock
5. Apply the resuscitation guidelines for septic shock

Immediate Life-Saving Strategies

1. A-B-C-D
1. Airway patent
2. Breathing
1. High fraction of inspired oxygen
2. Mechanical Ventilation
3. Circulation
1. Central venous and arterial access
2. Oxygen delivery
3. Oxygen consumption
4. Oxygen extraction ratio
4. Differential diagnosis
1. History
2. Physical exam
3. Laboratory data
2. Parameters to continuously monitor in all patients with shock
1. Arterial blood gas versus oximetry and capnography
2. Mixed venous blood gas
3. Lactate and Lactic acid
4. Cardiac output versus cardiac index
5. Central venous pressure versus global end diastolic index
6. Spinal cord dysfunction
7. Signs and symptoms
8. Treatment
3. Assessment and Treatment of Shock States
1. Cardiogenic
2. Hypovolemic
3. Septic
4. Neurogenic
5. Obstructive

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, physician assistants, nurse practitioners, 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 provide participants with numerous case studies to facilitate critical thinking. As a bedside clinical nurse specialist, he has developed several institution-wide protocols for the multidisciplinary assessment and management of the infectious disease and multi-system organ failure patient.

His presentations are enthusiastically delivered and offer highly practical tips that help make the most challenging concepts easy to understand. Linking knowledge to clinical practice is the goal of every education program. Speaker Disclosures:
Financial: Paul Langlois has employment relationships 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: Paul Langlois is a member of the American Nurses Association and the American Association of Critical Care Nurses.

For U.S. and Canadian customers, CE is available for $9.99 USD per participant. International CE rates may vary; please contact our Customer Service at 1-800-844-8260 for more details.

Listed below are the continuing education credit(s) currently available for this non-interactive self-study package. Please note, your state licensing board dictates whether self study is an acceptable form of continuing education. Please refer to your state rules and regulations.

Certificates of Successful Completion will be emailed, faxed or mailed to participants completing the post-test/evaluation and paying the CE fee.

**Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of mental health professionals. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your professions standards.

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners. For speaker disclosures, please see the faculty biography.

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Nurses/Nurse Practitioners/Clinical Nurse Specialists - Credit Expired: 12/9/2016
No CE available for this board.

California Nurses: PESI, Inc. is a provider approved by the California Board of Registered Nursing, Provider #:17118 for 1.0 self-study contact hours.

You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

Florida Nurses: PESI, Inc. is an approved provider by the Florida Board of Nursing. Provider #: FBN2858. These materials qualify for 1.0 self-study contact hours.

Iowa Nurses: PESI, Inc. is an approved provider by the Iowa Board of Nursing. Provider #: 346. Nurses successfully completing these self-study materials will earn 1.2 self-study contact hours.

Copies of the evaluation may be sent to the IBON. You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

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Other Professions
This self-study activity qualifies for 1.0 clock hours of instructional content as required by many national, state and local licensing boards and professional organizations. Retain your certificate of completion and contact your board or organization for specific filing requirements.

Disclaimer: **Information obtained in this course should be used within your scope of practice.
**It is your ethical responsibility to report accurate hours to your licensing board.
**All self-study participants must complete and pass (80% or better) a post-test and evaluation prior to receiving a certificate of completion. If you require a copy of the test/evaluation for CE purposes, please print at the time you take the test. Or you may call our customer service department and a copy of your test/evaluation will be emailed to you. Please allow 30-45 days.

Nurses, Advanced Practice Nurses, clinical Nurse Specialists, Nurse Practitioners, Physician Assistants