FERNE On-Line CME Program

Emergency Department Ischemic Stroke Patient Care:
Advanced Diagnostics and Therapeutics

Continuing Medical Education Credit Information

Purpose of Activity

The optimal diagnosis and treatment of acute stroke patients in the pre-hospital setting and in the ED requires an understanding of systems for stroke care, the way in which stroke severity can be best defined and communicated, when advanced diagnostic tests such as CTA, MRA and perfusion studies are indicated, how therapies such as IV and IA tPA thrombolysis and mechanical clot removal can be optimally utilized, and when triage and transfer to specialized stroke centers should rationally occur.

This session will provide an overview to the emergency physician of the current systems for stroke care, the way in which stroke patients should be clinically evaluated, and what are optimal treatment options based on the latest research, published guidelines, and available diagnostic and treatment modalities.

Needs Assessment

The planning process for this program was determined through four mechanisms:

1. Meeting feedback from participants via written evaluations at the 2007 Clinical Decision Making in Emergency Medicine: An Evidence-Based Conference and LLSA Review Meeting
2. Feedback from past FERNE meeting participants via written survey form
3. FERNE Executive and Advisory Boards
4. FERNE special meeting with faculty and residents in Emergency Medicine

Needs Assessment:

1. Previous AIS live course at Clinical Decision Making in Emergency Medicine 2007 revealed that through this mechanism:
   • A limited number of people could attend and learn from the materials onsite
   • Those who attended stated that the care of the AIS patient is an important learning need for EM physicians


2. Feedback through the FERNE survey revealed:
• Emergent care of ischemic stroke patients was the top learning need of EM physicians
• Learners desired more internet educational offerings


3. FERNE Executive Board is charged with the implementation of events to meet the FERNE mission statement:
   • To meet the need of it’s constituency, the FERNE Executive Board identified the need and desire to provide CME directly from the FERNE website.
   
   
4. SAEM Meeting with Residency Directors demonstrated:
• Stroke in particular is a topic of interest to most emergency physicians given that it is a common clinical presentation and that there are important ED treatment issues that require expertise on the part of the practicing emergency physician
• Because many hospitals are becoming JCAHO-certified stroke centers, it is important for emergency physicians to be able to obtain CME related to ischemic and hemorrhagic stroke
• AIS patient care is especially important because coverage by Interventional Radiologists is not the standard of care at all facilities, requiring the EM physician to learn optimal acute management prior to transfer

Target Audience

This educational activity has been developed for emergency physicians.

Method of Participation
This online educational program allows the learner three options for reviewing the content of this CME program, including:

View the video lecture: The archived lecture includes the speaker’s PowerPoint slide set, video, and audio. You may listen and view the lecture and / or slides.

Listen to the Lectures in MP3 format: The lecture recording is available for listening in MP3 format. The MP3 files are available for online listening or may be downloaded for remote listening. The MP3 files may also be played while viewing the PPT files independent of the video stream.

Print and Read the PowerPoint Slides, Key Clinical Concepts, and / or Overviews : The PowerPoint slide sets, Key Clinical Concepts, and Overviews are available for online viewing or may be downloaded and printed for remote reading.

All of these options will require up to two hours to complete. Completion of the CME assessment questions, evaluation, and CME request form are estimated to take approximately 15 minutes.

To complete this educational activity as designed, the participant should do the following: read the learning objectives (below); choose one of the three venues and review the content; and complete the CME assessment questions, an Evaluation Form, and a CME Request Form.

There is no fee for this program.

The participant must answer the CME assessment questions with 75% accuracy, complete an evaluation form and a CME request form all of which should either be submitted electronically through the FERNE website at www.ferne.org or be faxed back to the FERNE office to receive a CME certificate.

Release date: September 1, 2007
Expiration date: March 1, 2008

Learning Objectives

Upon completion of this program, the participant should be able to:

• Establish the key concepts that guide the decision making in the diagnosis and treatment of acute ischemic stroke patients.


• Evaluate stroke care systems, the role of tertiary and stroke centers, prehospital triage, and ED patient transfer in the management of acute ischemic stroke patients.


• Consider how CT, CTA, MRI, MRA, and perfusion studies can be used by emergency physicians in order to optimize IV tPA use, IR referral, and ED transfer to stroke specialty centers.


• Explore the role of interventional radiology diagnostic modalities, IA thrombolysis, and mechanical clot removal options in the treatment of ED acute ischemic stroke patients

Faculty Contributors

Andrew Asimos, MD, FACEP
Adjunct Associate Professor, University of North Caroline School of Medicine, Chapel Hill, North Carolina

E. Bradshaw Bunney, MD, FACEP
Associate Professor, EM Residency Program Director, University of Illinois, College of Medicine, Chicago, IL

J. Stephen Huff, MD, FACEP
Associate Professor, University of Virginia, Charlottesville, VA

David A. Miller, MD
Assistant Professor of Radiology, Mayo Clinic, Jacksonville, FL

Edward P. Sloan, MPH, FACEP
Professor, University of Illinois College of Medicine, Chicago, IL.


Production Staff

Charrise M.  O’Neill, RN, BS, CCRC
Executive Director, FERNE.

Fang Fang and Ting Huang
UIC Student Technical Support


Contributor Disclosures

In accordance with ACCME Standards and UIC policy, contributors must disclose to the program audience the existence of significant financial interests in or relationships with manufacturers of commercial products that might have a direct interest in the subject matter, as well as relationships with the commercial supporter of this CME activity. These contributors do not consider that such relationships will influence their contributions. Disclosure information provided by the contributors is as follows:

Drs. Asimos conducts research with FERNE/EMF and Boehringer Ingelheim grant support and has acted as a consultant for Novo Nordisk, Inc.

Dr. Bunney has had past lectures on behalf of FERNE supported through unrestricted educational grants from industry sources including Abbott, Concentric Medical, Eisai, (The) Medicines Company, Pfizer, and UCB Inc. Additionally, he is an officer for FERNE. He has participated in Advisory Boards on behalf of FERNE that were supported through unrestricted educational grants from industry sources including Concentric Medical and (The) Medicines Company.

Dr. Huff has been a member of the ACEP Clinical Policies Committee, and has had past lectures on behalf of FERNE supported through unrestricted educational grants from industry sources including Abbott, Concentric Medical, Eisai, (The) Medicines Company, Pfizer, and UCB Inc. Additionally, he is an officer for FERNE.

David A. Miller, MD has no disclosures to reveal.

Dr. Sloan has acted as a consultant to Abbott Laboratories, Eisai Inc, King Pharmaceuticals, and UCB Pharma. He is on the speakers’ bureau for Eisai, Inc. Dr. Sloan is an officer of FERNE. He has participated in Advisory Boards on behalf of FERNE that were supported through unrestricted educational grants from industry sources including Concentric Medical and (The) Medicines Company.

Acknowledgment of Commercial Support

This educational activity is supported by an unrestricted educational grant from Concentric Medical.

Accreditation Statement

”Emergency Department Ischemic Stroke Patient Care: Advanced Diagnostics and Therapeutics” has been planned and implemented in accordance with the Essentials Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the University of Illinois College of Medicine and FERNE.

The University of Illinois College of Medicine is accredited by the ACCME to provide continuing medical education for physicians. The University of Illinois at Chicago (UIC) College of Medicine designates this education activity for a maximum of 2.0 AMA PRA Category 1 credit(s)^TM. Physicians should claim only those credits commensurate with the extent of their participation in the activity.

Publisher's Notice

FERNE is pleased to make this CME activity available as a benefit to its constituency. Although the cost of creating this program has been underwritten by an educational grant from a commercial entity, FERNE and the presenters of this information had sole control of the content. Federal regulations, FERNE, UIC and ACCME policies prohibit commercial underwriters from directing or otherwise controlling the content of CME activities FERNE provides. Every effort has been made to ensure that the information presented is evidence based, fair, objective, and scientifically rigorous. This information is provided for the sole purpose of continuing medical education. Readers are advised to use their reasoned best judgment as to whether this information should result in a change in their patient care practices, and to note that FERNE does not endorse the use of any particular therapeutic agent or approach to treatment unless otherwise recommended in an ACEP Clinical Policy.

FERNE makes every effort to ensure that contributors to FERNE-sponsored programs are knowledgeable authorities in their fields. Participants are, nevertheless, advised that the statements and opinions expressed in this program are provided as guidelines and should not be construed as FERNE policy. The material contained herein is not intended to establish policy, procedure, or a standard of care. The views expressed in this educational activity are those of the contributors and not necessarily the opinion or recommendations of FERNE and Concentric Medical. FERNE and Concentric Medical disclaim any liability or responsibility for the consequences of any actions taken in reliance on those statements or opinions. Please send correspondence to ferne@ferne.org 

Please be sure to review the presentations before you take this test and answer the evaluation questions. By completing this test and receiving your CME certificate, you are attesting that you have completed the entire program as described in "Method of Participation" on the CME page.