FERNE On-Line CME Program

Optimizing the ED Management of
Intracerebral Hemorrhage Patients

Continuing Medical Education Credit Information

Purpose of Activity
ICH is a devastating disease that often causes patients to present to the Emergency Department in critical condition, with unstable vital signs, altered mental status, and in need of urgent airway management.  It is incumbent on the emergency physician to quickly stabilize these patients, diagnose their condition, and decide on urgent treatment strategies that will optimize the chances for a good outcome.  This symposium is designed to make it possible for the emergency physician to have the knowledge and skills necessary to consistently make this happen for ED ICH patients.

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

1. Meeting feedback from participants via written evaluations at the 2005 ACEP Scientific Assembly
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 ICH live course at 2005 ACEP Scientific Assembly 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 ICH patient is an important learning need for EM physicians


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


3. FERNE Executive Board is charged with the implementation of events to meet the FERNE mission statement:
   • To meet the need of its 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
   • ICH patient care is especially important because neurosurgery coverage is on the decline, 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 via MS Producer:  the live lecture is included along with the speaker’s PowerPoint slide set.  This synchronistic program is produced in Microsoft Producer which is a free, downloadable Windows program.

 View the PowerPoint slide set with Annotations: the speaker’s PowerPoint slide set includes his annotated comments from the meeting.  Available for online viewing or may be downloaded.

Listen to the lectures in MP3 format: the live lecture has been made available for listening in MP3 format.  Available for online listening or may be downloaded.

All of these options will require up to three 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; read the 2007 Update, 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 which should be faxed back to the FERNE office to receive a CME certificate.

Release date: February, 2007
Expiration date: February, 2008

Learning Objectives

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

• Review the current concepts related to the pathophysiology and presentation of patients who require ED treatment for intracerebral hemorrhage.


• Discuss ways in which the diagnosis and treatment of ED ICH patients can be optimized based on available options and published clinical guidelines and current publications.


• Describe the optimal CT diagnosis and ED treatment of patients who present with stroke symptoms consistent with a possible intracerebral hemorrhage.


• Determine the specific operative and non-operative management strategies in patients with intracerebral hemorrhage.


• Understand MRI/MRA indications in the diagnosis of hemorrhagic stroke, SAH, and ICH patients.


• Establish optimal ways to treat ED ICH patients who present with an elevated INR as a result of Coumadin use.

Faculty  Contributors

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

Marc Dorfman, MD, FACEP, MACP
EM Residency Program Director, Resurrection Medical Center, Chicago, IL.

Edward Jauch, MD, MS, FACEP
Assistant Professor, University of Cincinnati. Cincinnati, OH.

Brian Stettler, MD, FACEP
Assistant Professor Clin Geo, University of Cincinnati, Cincinnati, OH.

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.

Jonathan Kaplan and Li Liu
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.

Drs. Dorfman and Stettler have no disclosures.

Dr. Jauch has acted as a consultant and principal investigator for Novo Nordisk.

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.

The production staff had no financial interests or relationships to disclose. This program presentation includes discussion of the drug Factor VIIa, which has US FDA approval for use in hemophilia but is not approved for emergency department use. UIC and FERNE expect all contributors to present information in an objective, unbiased manner without endorsement or criticism of specific products or services. UIC and FERNE also expect that the relationships contributors disclose will not influence their contributions.

Acknowledgment of Commercial Support
This educational activity is supported by an unrestricted educational grant from Novo Nordisk Pharmaceuticals.

Accreditation Statement

”Optimizing the ED Management of Intracerebral Hemorrhage Patients”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 3.0 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 Novo Nordisk Pharmaceuticals.  FERNE and Novo Nordisk Pharmaceuticals 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.