2025 PACUPrep BCCCP Preparatory Course
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Pulmonary
ARDS4 Topics|1 Quiz -
Asthma Exacerbation4 Topics|1 Quiz
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COPD Exacerbation4 Topics|1 Quiz
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Cystic Fibrosis6 Topics|1 Quiz
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Foundational Principles of Cystic Fibrosis in Critical Care
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Empiric Antibiotic Management of Acute Cystic Fibrosis Pulmonary Exacerbations
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Airway Clearance and Adjunctive Pharmacotherapy in Hospitalized Cystic Fibrosis
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Critical Care Management of Cystic Fibrosis
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Nutritional Support and Pancreatic Enzyme Therapy in ICU Cystic Fibrosis
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Monitoring, Prevention, and Transition of Care in Critically Ill Cystic Fibrosis Patients
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Foundational Principles of Cystic Fibrosis in Critical Care
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Drug-Induced Pulmonary Diseases3 Topics|1 Quiz
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Mechanical Ventilation Pharmacotherapy5 Topics|1 Quiz
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Pharmacologic Management of Mechanically Ventilated Critically Ill Patients
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Pharmacologic Management of Mechanically Ventilated Patients
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Pharmacotherapy and Monitoring of Neuromuscular Blocking Agents in Mechanically Ventilated Patients
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Pharmacotherapy for Prevention and Management of Mechanical Ventilation-Associated Complications
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Pharmacotherapy in Mechanical Ventilation
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Pharmacologic Management of Mechanically Ventilated Critically Ill Patients
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Pleural Disorders5 Topics|1 Quiz
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Foundational Concepts in Pleural Disorders
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Diagnostic and Severity Assessment in Pleural Disorders
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Pharmacotherapy and Adjunctive Medical Management of Pleural Disorders
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Procedural and Post-Procedure Management in Pleural Drainage
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Management of Pleural Disorders in Special Populations and Complex Scenarios
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Foundational Concepts in Pleural Disorders
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Pulmonary Hypertension (Acute and Chronic severe pulmonary hypertension)5 Topics|1 Quiz
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Foundational Principles & Classification of Pulmonary Hypertension
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Hemodynamic and Imaging-Based Severity Assessment in Critical Pulmonary Hypertension
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Acute Pharmacologic Management of Decompensated Pulmonary Hypertension
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Individualized Chronic Management and Discharge Planning in Severe Pulmonary Hypertension
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Monitoring and Supportive Care Strategies for Special Pulmonary Hypertension Populations in the ICU
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Foundational Principles & Classification of Pulmonary Hypertension
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CardiologyAcute Coronary Syndromes6 Topics|1 Quiz
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Differentiation of Acute Coronary Syndromes: Biomarkers, Clinical Presentation, and ECG Criteria
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Risk Stratification and Timing of Invasive Strategy in Acute Coronary Syndromes
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Antiplatelet Therapy in ACS: Selection, Loading, and Duration
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Anticoagulation Strategies in Acute Coronary Syndromes
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Management of Acute ACS Complications & Secondary Prevention
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Reperfusion Strategies in Acute Coronary Syndromes
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Differentiation of Acute Coronary Syndromes: Biomarkers, Clinical Presentation, and ECG Criteria
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Atrial Fibrillation and Flutter6 Topics|1 Quiz
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Fundamental Principles of Atrial Tachyarrhythmias
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Diagnosis and Classification of Atrial Arrhythmias
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Management of Unstable Atrial Arrhythmias: Emergency Cardioversion and Procainamide Strategy
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Acute IV Pharmacotherapy for Stable Atrial Fibrillation and Flutter
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Thromboembolism Prevention and Anticoagulation Management in the ICU
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Pharmacologic Strategies for Acute Management of Supraventricular Tachycardia
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Fundamental Principles of Atrial Tachyarrhythmias
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Cardiogenic Shock4 Topics|1 Quiz
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Heart Failure7 Topics|1 Quiz
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Integration of Natriuretic Peptides and Pulmonary Artery Catheter Hemodynamics in ADHF
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Optimizing Loop Diuretic Therapy and Resistance Management in ADHF
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Vasoactive Agent Selection and Titration in Acute Decompensated Heart Failure
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Acute Decompensated Heart Failure: Advanced Pharmacotherapy and Supportive Management
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Phenotype-Specific Management of Acute Decompensated Heart Failure
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Acute Decompensated Heart Failure in the ICU: Management and Transition
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Recovery, De-Escalation, and Safe Transition of Care in Acute Decompensated Heart Failure
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Integration of Natriuretic Peptides and Pulmonary Artery Catheter Hemodynamics in ADHF
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Hypertensive Crises5 Topics|1 Quiz
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Foundational Principles of Hypertensive Crises
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Diagnostic and Classification Strategies in Hypertensive Crises
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IV Pharmacotherapy Planning in Hypertensive Emergencies
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Pharmacologic Management and Blood Pressure Targets in Hypertensive Crises
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Monitoring, Over-Reduction Prevention, and Care Transitions in Hypertensive Emergencies
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Foundational Principles of Hypertensive Crises
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Ventricular Arrhythmias and Sudden Cardiac Death Prevention5 Topics|1 Quiz
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Fundamentals of Monomorphic and Polymorphic Ventricular Tachycardia
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ECG Patterns and Stability Assessment in Ventricular Tachycardia
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Acute Management of Ventricular Tachycardias
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Acute Ventricular Tachycardia: Pharmacologic and Electrical Management and SCD Prevention
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Secondary Prevention of Ventricular Tachyarrhythmias and Sudden Cardiac Death
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Fundamentals of Monomorphic and Polymorphic Ventricular Tachycardia
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NEPHROLOGYAcute Kidney Injury (AKI)5 Topics|1 Quiz
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Acute Kidney Injury: Foundations, Management, and Recovery
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Acute Kidney Injury: Diagnosis, Classification, and Pharmacotherapy Optimization
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Pharmacotherapy Optimization and Dosing in Acute Kidney Injury
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Pharmacotherapy Optimization and Supportive Care in Acute Kidney Injury
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Optimizing Pharmacotherapy and Management in Acute Kidney Injury
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Acute Kidney Injury: Foundations, Management, and Recovery
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Contrast‐Induced Nephropathy5 Topics|1 Quiz
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Contrast-Induced Nephropathy: Pathophysiology, Prevention, and Management
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Contrast‐Induced Nephropathy: Pathophysiology, Prophylaxis, and Management
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Contrast-Induced Nephropathy: Prevention and Management
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Contrast‐Induced Nephropathy: Pharmacologic Prophylaxis and Supportive Care
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Pharmacologic Prophylaxis of Contrast-Induced Nephropathy
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Contrast-Induced Nephropathy: Pathophysiology, Prevention, and Management
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Drug‐Induced Kidney Diseases5 Topics|1 Quiz
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Rhabdomyolysis5 Topics|1 Quiz
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Syndrome of Inappropriate Antidiuretic Hormone (SIADH)5 Topics|1 Quiz
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Pathophysiology, Etiologies, and Clinical Manifestations of SIADH
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Syndrome of Inappropriate Antidiuretic Hormone (SIADH) in Critical Care: Diagnosis, Management, and Transitions
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Therapeutic Management of SIADH
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Monitoring and Management of Hyponatremia Correction in SIADH
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Pharmacotherapy and Management of SIADH
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Pathophysiology, Etiologies, and Clinical Manifestations of SIADH
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Renal Replacement Therapies (RRT)5 Topics|1 Quiz
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NeurologyStatus Epilepticus5 Topics|1 Quiz
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Acute Ischemic Stroke5 Topics|1 Quiz
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Subarachnoid Hemorrhage5 Topics|1 Quiz
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Spontaneous Intracerebral Hemorrhage5 Topics|1 Quiz
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Neuromonitoring Techniques5 Topics|1 Quiz
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Neuromonitoring and Ventriculostomy Management in Neurocritical Care
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Neuromonitoring and Ventriculostomy Management
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Neuromonitoring Data Interpretation and Clinical Application
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Neuromonitoring and Ventriculostomy Management in Neurocritical Care
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Ventriculostomy Management and Complication Prevention
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Neuromonitoring and Ventriculostomy Management in Neurocritical Care
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GastroenterologyAcute Upper Gastrointestinal Bleeding5 Topics|1 Quiz
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Foundational Concepts in Acute Upper Gastrointestinal Bleeding
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Diagnostic Evaluation and Risk Stratification in Acute Upper Gastrointestinal Bleeding
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Management of Acute Upper Gastrointestinal Bleeding
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Management of Acute Upper Gastrointestinal Bleeding
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Management of Acute Upper Gastrointestinal Bleeding
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Foundational Concepts in Acute Upper Gastrointestinal Bleeding
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Acute Lower Gastrointestinal Bleeding5 Topics|1 Quiz
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Foundational Concepts in Acute Lower Gastrointestinal Bleeding
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Foundational Concepts in Acute Lower Gastrointestinal Bleeding
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Foundational Principles and Management Framework for Acute Lower Gastrointestinal Bleeding
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Acute Lower Gastrointestinal Bleeding Management in Critical Care
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Management of Acute Lower Gastrointestinal Bleeding in Critically Ill Patients
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Foundational Concepts in Acute Lower Gastrointestinal Bleeding
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Acute Pancreatitis5 Topics|1 Quiz
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Enterocutaneous and Enteroatmospheric Fistulas5 Topics|1 Quiz
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Enterocutaneous and Enteroatmospheric Fistulas
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Enterocutaneous and Enteroatmospheric Fistulas: Foundations and Management
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Pharmacotherapy and Supportive Management of Enterocutaneous and Enteroatmospheric Fistulas
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Management Strategies for Enterocutaneous and Enteroatmospheric Fistulas in Critical Care
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Management of Enterocutaneous and Enteroatmospheric Fistulas
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Enterocutaneous and Enteroatmospheric Fistulas
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Ileus and Acute Intestinal Pseudo-obstruction5 Topics|1 Quiz
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Foundational Concepts in Ileus and Acute Intestinal Pseudo-Obstruction
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Ileus and Acute Intestinal Pseudo-obstruction in Critically Ill Patients
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Pharmacologic and Supportive Management of Ileus and Acute Intestinal Pseudo-Obstruction
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Ileus and Acute Intestinal Pseudo-obstruction
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Management of Ileus and Acute Intestinal Pseudo-obstruction in the Critically Ill
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Foundational Concepts in Ileus and Acute Intestinal Pseudo-Obstruction
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Abdominal Compartment Syndrome5 Topics|1 Quiz
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HepatologyAcute Liver Failure5 Topics|1 Quiz
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Foundational Principles and Pathophysiology of Acute Liver Failure
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Diagnostic Criteria and Severity Stratification in Acute Liver Failure
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Evidence-Based Pharmacotherapy Planning in Acute Liver Failure
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Supportive Care Strategies for Managing Complications in Acute Liver Failure
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Recovery, De-escalation, and Transition of Care in Acute Liver Failure
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Foundational Principles and Pathophysiology of Acute Liver Failure
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Portal Hypertension & Variceal Hemorrhage5 Topics|1 Quiz
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Foundations of Portal Hypertension: Epidemiology, Pathophysiology, and Risk Factors
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Diagnostic Evaluation and Risk Stratification in Variceal Hemorrhage
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Pharmacotherapy Strategies for Prophylaxis and Acute Management of Variceal Hemorrhage
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Supportive Care & Complication Monitoring in Acute Variceal Hemorrhage
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Recovery, De-escalation, and Transition of Care After Variceal Hemorrhage
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Foundations of Portal Hypertension: Epidemiology, Pathophysiology, and Risk Factors
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Hepatic Encephalopathy5 Topics|1 Quiz
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Foundational Principles and Pathophysiology of Hepatic Encephalopathy
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Diagnosis and Classification of Hepatic Encephalopathy
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Escalating Pharmacotherapy Strategies in Critically Ill Hepatic Encephalopathy
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Supportive Care and Monitoring in Hepatic Encephalopathy
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Recovery, De‐escalation, and Transition of Care in Hepatic Encephalopathy
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Foundational Principles and Pathophysiology of Hepatic Encephalopathy
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Ascites & Spontaneous Bacterial Peritonitis5 Topics|1 Quiz
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Foundational Principles of Ascites & SBP: Epidemiology, Pathophysiology, and Risk Factors
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Diagnostic & Classification Strategies for Ascites & SBP
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Advanced Pharmacotherapy of Ascites & SBP in the Critically Ill
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Supportive Care and Monitoring in Ascites & SBP
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Recovery, De-Escalation, and Safe Transitions in Ascites & SBP
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Foundational Principles of Ascites & SBP: Epidemiology, Pathophysiology, and Risk Factors
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Hepatorenal Syndrome5 Topics|1 Quiz
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Foundational Principles: Epidemiology, Pathophysiology, and Risk Factors
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Diagnostic and Classification Strategies for Hepatorenal Syndrome
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Pharmacotherapy Planning: Vasoconstrictor and Albumin Strategies
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Supportive ICU Management and Complication Mitigation
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Therapeutic De-escalation, Enteral Conversion, and Transition Planning
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Foundational Principles: Epidemiology, Pathophysiology, and Risk Factors
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Drug-Induced Liver Injury5 Topics|1 Quiz
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Foundational Principles of Drug-Induced Liver Injury
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Diagnostics and Classification of Drug-Induced Liver Injury
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Pharmacotherapy Strategies for Drug-Induced Liver Injury
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Supportive Care and Complication Management in Drug-Induced Liver Injury
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Patient Recovery, Rehabilitation, and Transition of Care Post-DILI
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Foundational Principles of Drug-Induced Liver Injury
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DermatologyStevens-Johnson Syndrome and Toxic Epidermal Necrolysis5 Topics|1 Quiz
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Erythema multiforme5 Topics|1 Quiz
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Drug Reaction (or Rash) with Eosinophilia and Systemic Symptoms (DRESS)5 Topics|1 Quiz
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ImmunologyTransplant Immunology & Acute Rejection5 Topics|1 Quiz
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Foundational Principles and Risk Factors in Transplant Immunology & Acute Rejection
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Diagnostic Criteria and Classification Systems for Acute Transplant Rejection
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Pharmacotherapy Strategies for Prevention and Treatment of Acute Transplant Rejection
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Supportive Care and Complication Management in Acute Transplant Rejection
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Recovery Optimization and Transition of Care Post-Acute Rejection
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Foundational Principles and Risk Factors in Transplant Immunology & Acute Rejection
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Solid Organ & Hematopoietic Transplant Pharmacotherapy5 Topics|1 Quiz
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Foundations of Transplant Pharmacotherapy: Epidemiology, Pathophysiology, and Risk Factors
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Diagnostics and Classification Systems in Transplant Pharmacotherapy
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Designing Escalating Immunosuppressive Therapy in Critically Ill Transplant Patients
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Supportive Care and ICU-Level Complication Management in Transplant Recipients
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Weaning, Enteral Conversion, PICS Mitigation, and Discharge Planning in Transplant Patients
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Foundations of Transplant Pharmacotherapy: Epidemiology, Pathophysiology, and Risk Factors
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Graft-Versus-Host Disease (GVHD)5 Topics|1 Quiz
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Hypersensitivity Reactions & Desensitization5 Topics|1 Quiz
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Foundational Principles of Hypersensitivity Reactions and Desensitization
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Diagnostic Strategies and Classification of Hypersensitivity Reactions
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Pharmacotherapy Planning for Acute Hypersensitivity Reactions
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Supportive Care and Complication Management in Hypersensitivity Reactions
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Recovery, De-escalation, and Transition of Care Strategies
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Foundational Principles of Hypersensitivity Reactions and Desensitization
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Biologic Immunotherapies & Cytokine Release Syndrome5 Topics|1 Quiz
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Fundamentals of Biologic Immunotherapies & CRS: Epidemiology, Pathophysiology, and Risk Factors
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Diagnostic Evaluation and Classification of CRS
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Pharmacotherapy Planning and Dose Optimization in CRS
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Supportive Care and Monitoring of CRS-Associated Complications
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Recovery, Mitigation of Long-Term Sequelae, and Transition of Care Post-CRS
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Fundamentals of Biologic Immunotherapies & CRS: Epidemiology, Pathophysiology, and Risk Factors
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EndocrinologyRelative Adrenal Insufficiency and Stress-Dose Steroid Therapy5 Topics|1 Quiz
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Hyperglycemic Crisis (DKA & HHS)5 Topics|1 Quiz
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Foundational Principles and Epidemiology of Hyperglycemic Crises
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Diagnostic Evaluation and Severity Stratification of DKA and HHS
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Escalating Pharmacotherapy in Hyperglycemic Crises
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Supportive Care and Complication Management in Hyperglycemic Crises
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Weaning, Transition, and Safe Handoff Post-Hyperglycemic Crisis
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Foundational Principles and Epidemiology of Hyperglycemic Crises
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Glycemic Control in the ICU5 Topics|1 Quiz
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Foundational Principles and Risk Factors of Dysglycemia in Critical Illness
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Diagnostic Assessment and Classification of Dysglycemia in the ICU
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Pharmacotherapy Strategies for Dysglycemia in the ICU
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Supportive Care and Management of Dysglycemia-Related Complications
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Weaning, Transition, and Discharge Planning after ICU Glycemic Management
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Foundational Principles and Risk Factors of Dysglycemia in Critical Illness
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Thyroid Emergencies: Thyroid Storm & Myxedema Coma5 Topics|1 Quiz
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Foundations of Thyroid Emergencies: Epidemiology, Pathophysiology, and Risk Factors
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Diagnosis and Severity Stratification of Thyroid Emergencies
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Advanced Pharmacotherapy in Thyroid Emergencies
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Supportive Care and Complication Monitoring in Thyroid Emergencies
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Recovery, Transition of Care, and Long-Term Management
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Foundations of Thyroid Emergencies: Epidemiology, Pathophysiology, and Risk Factors
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HematologyAcute Venous Thromboembolism5 Topics|1 Quiz
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Foundational Principles of Acute Venous Thromboembolism
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Diagnosis and Risk Stratification of Acute Venous Thromboembolism
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Pharmacotherapy Strategies for Acute VTE in Critically Ill Patients
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Supportive Care and Complication Management in Acute VTE
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Recovery, De-escalation, and Transition of Care in VTE
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Foundational Principles of Acute Venous Thromboembolism
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Drug-Induced Thrombocytopenia5 Topics|1 Quiz
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Foundational Principles, Pathophysiology, and Risk Factors of Drug-Induced Thrombocytopenia
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Diagnostic and Classification Frameworks for Drug-Induced Thrombocytopenia
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Evidence-Based Pharmacotherapy Strategies for Drug-Induced Thrombocytopenia
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Supportive Care and Complication Management in Drug-Induced Thrombocytopenia
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Recovery Facilitation and Safe Transition of Care in Drug-Induced Thrombocytopenia
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Foundational Principles, Pathophysiology, and Risk Factors of Drug-Induced Thrombocytopenia
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Anemia of Critical Illness5 Topics|1 Quiz
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Foundational Principles: Epidemiology, Pathophysiology, and Risk Factors
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Diagnostic Evaluation and Classification of Anemia in Critical Illness
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Pharmacotherapeutic Strategies in Anemia of Critical Illness
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Supportive Care and Management of Complications in Anemia of Critical Illness
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Recovery, De-escalation, and Transition of Care
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Foundational Principles: Epidemiology, Pathophysiology, and Risk Factors
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Drug-Induced Hematologic Disorders5 Topics|1 Quiz
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Foundational Concepts: Epidemiology, Pathophysiology, and Risk Factors
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Diagnostic Assessment and Classification of Drug-Induced Hematologic Disorders
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Escalating Pharmacotherapy Strategies for Drug-Induced Hematologic Disorders
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Supportive Care and Monitoring in Drug-Induced Hematologic Disorders
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Recovery, De-Escalation, and Transitions of Care
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Foundational Concepts: Epidemiology, Pathophysiology, and Risk Factors
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Sickle Cell Crisis in the ICU5 Topics|1 Quiz
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Foundational Principles and Risk Stratification in Sickle Cell Crisis
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Diagnostic and Classification Criteria for Sickle Cell Crisis
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Pharmacotherapy Strategies in ICU Management of Sickle Cell Crisis
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Supportive Care and Complication Prevention in Sickle Cell Crisis
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Recovery, De-escalation, and Transition of Care for Sickle Cell Crisis Patients
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Foundational Principles and Risk Stratification in Sickle Cell Crisis
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Methemoglobinemia & Dyshemoglobinemias5 Topics|1 Quiz
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Foundational Principles and Pathophysiology of Methemoglobinemia & Dyshemoglobinemias
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Diagnostic Criteria and Severity Classification in Methemoglobinemia & Dyshemoglobinemias
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Pharmacotherapy Strategies for Methemoglobinemia & Dyshemoglobinemias
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Supportive Care, Monitoring, and Complication Management in Methemoglobinemia & Dyshemoglobinemias
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Recovery, De-escalation, and Transition of Care in Methemoglobinemia & Dyshemoglobinemias
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Foundational Principles and Pathophysiology of Methemoglobinemia & Dyshemoglobinemias
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ToxicologyToxidrome Recognition and Initial Management5 Topics|1 Quiz
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Management of Acute Overdoses – Non-Cardiovascular Agents5 Topics|1 Quiz
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Foundational Concepts and Risk Factors in Non-Cardiovascular Acute Overdoses
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Diagnostic Assessment and Severity Classification for Non-Cardiovascular Overdoses
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Pharmacotherapeutic Management and Enhanced Elimination Strategies
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Supportive Care, Monitoring, and Complication Management
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De-escalation, Recovery, and Safe Transition of Care
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Foundational Concepts and Risk Factors in Non-Cardiovascular Acute Overdoses
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Management of Acute Overdoses – Cardiovascular Agents5 Topics|1 Quiz
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Foundational Principles: Epidemiology, Pathophysiology, and Risk Factors
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Diagnostic and Classification Strategies in Acute Overdoses
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Pharmacotherapy: Escalating Evidence-Based Treatment
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Supportive Care, Complication Prevention, and Multidisciplinary Decision-Making
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De-escalation, Transition of Care, and Long-Term Recovery
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Foundational Principles: Epidemiology, Pathophysiology, and Risk Factors
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Toxic Alcohols and Small-Molecule Poisons5 Topics|1 Quiz
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Foundational Principles: Epidemiology, Pathophysiology, and Risk Factors
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Diagnostics and Classification Criteria for Toxic Alcohol Poisoning
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Escalating Pharmacotherapy Planning for Toxic Alcohol Poisoning
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Supportive ICU Care and Complication Prevention
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Therapy De-escalation, Post-ICU Recovery, and Transition of Care
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Foundational Principles: Epidemiology, Pathophysiology, and Risk Factors
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Antidotes and Gastrointestinal Decontamination5 Topics|1 Quiz
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Foundations of Toxic Epidemiology, Pathophysiology, and Risk Factors
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Diagnostic Assessment and Risk Stratification in Poisoned Patients
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Escalating Antidotal Pharmacotherapy and Adjunctive Therapies
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Supportive Care, Complication Prevention, and Multidisciplinary Decision-Making
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Weaning and Transition of Care: From Antidote Infusions to ICU Recovery and Discharge Planning
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Foundations of Toxic Epidemiology, Pathophysiology, and Risk Factors
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Extracorporeal Removal Techniques5 Topics|1 Quiz
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Foundational Principles of Extracorporeal Removal Techniques
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Diagnostic and Classification Criteria for Extracorporeal Intervention
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Evidence‐Based Planning and Modality Selection
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Supportive Care and Complication Prevention During Extracorporeal Therapy
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Weaning, Pharmacotherapy Transition, and Post‐Extracorporeal Recovery
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Foundational Principles of Extracorporeal Removal Techniques
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Withdrawal Syndromes in the ICU5 Topics|1 Quiz
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Foundational Principles of ICU Withdrawal Syndromes
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Diagnostics and Classification of ICU Withdrawal Syndromes
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Evidence-Based Pharmacotherapy for ICU Withdrawal Syndromes
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Supportive Care and Complication Management in ICU Withdrawal Syndromes
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Weaning, Conversion, and Transition of Care in ICU Withdrawal Syndromes
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Foundational Principles of ICU Withdrawal Syndromes
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Infectious DiseasesSepsis and Septic Shock5 Topics|1 Quiz
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Foundational Principles: Epidemiology, Pathophysiology, and Risk Factors of Sepsis and Septic Shock
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Diagnostic Criteria and Severity Stratification in Sepsis and Septic Shock
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Escalating Pharmacotherapy in Sepsis and Septic Shock
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Supportive Care and Complication Prevention in Sepsis and Septic Shock
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Recovery, Rehabilitation, and Transition of Care Post-Sepsis
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Foundational Principles: Epidemiology, Pathophysiology, and Risk Factors of Sepsis and Septic Shock
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Pneumonia (CAP, HAP, VAP)5 Topics|1 Quiz
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Foundational Principles of Pneumonia: Epidemiology, Pathophysiology & Risk Factors
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Diagnostics & Classification: Clinical, Laboratory & Scoring Tools
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Escalating Pharmacotherapy for Critically Ill Pneumonia Patients
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Supportive Care & Complication Monitoring in Pneumonia
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De-escalation, Recovery & Safe Transition of Care
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Foundational Principles of Pneumonia: Epidemiology, Pathophysiology & Risk Factors
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Endocarditis5 Topics|1 Quiz
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Foundational Principles: Epidemiology, Pathophysiology, and Risk Factors
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Diagnostic and Classification Criteria in Endocarditis
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Evidence-Based Pharmacotherapy Strategies for Endocarditis
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Supportive Care and Management of Complications in Endocarditis
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Transition of Care, De-Escalation, and Recovery Planning
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Foundational Principles: Epidemiology, Pathophysiology, and Risk Factors
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CNS Infections5 Topics|1 Quiz
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Foundational Principles: Epidemiology, Pathophysiology, and Risk Factors of CNS Infections
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Diagnostic Evaluation and Severity Stratification in CNS Infections
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Escalating Pharmacotherapy Strategies for Critically Ill Patients with CNS Infections
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Adjunctive Supportive Care and Complication Management in CNS Infections
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Recovery, Rehabilitation, and Transition of Care in CNS Infections
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Foundational Principles: Epidemiology, Pathophysiology, and Risk Factors of CNS Infections
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Complicated Intra-abdominal Infections5 Topics|1 Quiz
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Antibiotic Stewardship & PK/PD5 Topics|1 Quiz
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Foundational Principles of Antibiotic Stewardship & PK/PD in Critical Care
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Diagnostic Criteria and Risk Stratification for Antimicrobial Stewardship in Critical Care
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Evidence-Based Pharmacotherapy Planning and PK/PD Optimization in Critically Ill Patients
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Supportive Care and Management of Antimicrobial-Related Complications in the ICU
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De-escalation Strategies and Transition of Care Post-Antimicrobial Therapy
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Foundational Principles of Antibiotic Stewardship & PK/PD in Critical Care
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Clostridioides difficile Infection5 Topics|1 Quiz
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Febrile Neutropenia & Immunocompromised Hosts5 Topics|1 Quiz
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Epidemiology, Pathophysiology, and Risk Factors of Febrile Neutropenia
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Diagnostic Evaluation and Risk Stratification in Febrile Neutropenia
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Empiric Antimicrobial Pharmacotherapy and Dosing in Febrile Neutropenia
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Supportive Care and Critical Care Management in Febrile Neutropenia
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Recovery, De-Escalation, and Transition of Care in Febrile Neutropenia
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Epidemiology, Pathophysiology, and Risk Factors of Febrile Neutropenia
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Skin & Soft-Tissue Infections / Acute Osteomyelitis5 Topics|1 Quiz
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Urinary Tract and Catheter-related Infections5 Topics|1 Quiz
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Foundational Principles of Urinary Tract and Catheter-related Infections
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Diagnostic Criteria and Severity Stratification for Urinary Tract and Catheter-related Infections
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Designing Evidence-Based Pharmacotherapy for Urinary Tract and Catheter-related Infections in Critically Ill Patients
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Supportive Care and Management of Complications Associated with Urinary Tract and Catheter-related Infections
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Antimicrobial De-escalation, IV-to-Oral Conversion, and Safe Transition of Care
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Foundational Principles of Urinary Tract and Catheter-related Infections
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Pandemic & Emerging Viral Infections5 Topics|1 Quiz
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Foundational Principles and Risk Factors in Pandemic & Emerging Viral Infections
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Diagnostics and Severity Classification in Pandemic & Emerging Viral Infections
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Escalating Pharmacotherapy for Pandemic & Emerging Viral Infections
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Supportive Care and Monitoring in Pandemic & Emerging Viral Infections
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Recovery, De-escalation, and Transition of Care in Pandemic & Emerging Viral Infections
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Foundational Principles and Risk Factors in Pandemic & Emerging Viral Infections
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Supportive Care (Pain, Agitation, Delirium, Immobility, Sleep)Pain Assessment and Analgesic Management5 Topics|1 Quiz
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Foundational Principles of Pain Assessment and Analgesic Management
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Diagnostic and Classification Strategies for Pain Assessment in Critically Ill Patients
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Evidence-Based Escalating Pharmacotherapy for ICU Pain Management
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Supportive Care Measures and Monitoring for Pain-Related Complications
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Analgesic De-escalation, Weaning, and Transition of Care
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Foundational Principles of Pain Assessment and Analgesic Management
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Sedation and Agitation Management5 Topics|1 Quiz
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Foundations of Sedation and Agitation: Epidemiology, Pathophysiology, and Risk Assessment
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Diagnostic Assessment and Classification of Sedation and Agitation in the ICU
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Evidence-based Pharmacotherapy for Sedation and Agitation in Critical Illness
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Supportive Care and Monitoring of Complications in Sedation and Agitation Management
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Weaning, Transition, and Post-ICU Care in Sedation Management
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Foundations of Sedation and Agitation: Epidemiology, Pathophysiology, and Risk Assessment
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Delirium Prevention and Treatment5 Topics|1 Quiz
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Sleep Disturbance Management5 Topics|1 Quiz
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Foundational Principles: Epidemiology, Pathophysiology, and Risk Factors of ICU Sleep Disturbances
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Assessment and Classification of ICU Sleep Disturbances
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Pharmacologic Management: Designing an Evidence-Based Escalation Plan
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Supportive Care, Environmental Strategies, and Monitoring
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Recovery, De-Escalation, and Transition of Care
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Foundational Principles: Epidemiology, Pathophysiology, and Risk Factors of ICU Sleep Disturbances
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Immobility and Early Mobilization5 Topics|1 Quiz
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Foundational Principles and Risk Factors for Immobility and ICU‐Acquired Weakness
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Diagnostic and Classification Criteria for Immobility‐Related Complications
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Evidence‐Based Pharmacotherapy Planning to Optimize Early Mobilization
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Supportive Care Measures and Management of Complications
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Recovery Pathways and Safe Transition of Care
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Foundational Principles and Risk Factors for Immobility and ICU‐Acquired Weakness
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Oncologic Emergencies5 Topics|1 Quiz
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Pathophysiology and Clinical Presentations of ICU‐Relevant Oncologic Emergencies
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Diagnostic Assessment and Risk Stratification in Oncologic Emergencies
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Evidence‐Based Pharmacologic Management of Oncologic Emergencies
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ICU‐Level Supportive Care and Complication Prevention in Oncologic Emergencies
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Transition‐of‐Care and De‐escalation Strategies Post‐Oncologic Emergencies
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Pathophysiology and Clinical Presentations of ICU‐Relevant Oncologic Emergencies
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End-of-Life Care & Palliative CareGoals of Care & Advance Care Planning5 Topics|1 Quiz
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Foundational Principles and Frameworks of Goals of Care & Advance Care Planning
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Patient Stratification and Prioritization for Advance Care Planning
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Pharmacotherapy Alignment with Patient-Defined Goals in Critical Care
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Supportive Symptom Management and Monitoring in Comfort-Focused Care
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Structured Communication and Interprofessional Collaboration for Goals of Care Transitions
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Foundational Principles and Frameworks of Goals of Care & Advance Care Planning
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Pain Management & Opioid Therapy5 Topics|1 Quiz
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Dyspnea & Respiratory Symptom Management5 Topics|1 Quiz
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Sedation & Palliative Sedation5 Topics|1 Quiz
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Foundational Principles: Epidemiology, Pathophysiology, and Risk Factors of Sedation
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Diagnostic Assessment: Sedation Depth and Refractory Symptom Classification
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Pharmacotherapy Planning: Escalation Strategies for Sedation and Palliative Sedation
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Supportive Care and Monitoring during Deep Sedation
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Weaning Protocols and Continuity of Care Post-Sedation
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Foundational Principles: Epidemiology, Pathophysiology, and Risk Factors of Sedation
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Delirium Agitation & Anxiety5 Topics|1 Quiz
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Foundational Principles of ICU Delirium, Agitation & Anxiety
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Diagnostic Assessment and Classification in ICU Delirium, Agitation & Anxiety
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Pharmacotherapy Strategies for ICU Delirium, Agitation & Anxiety
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Supportive Care and Monitoring in ICU Delirium, Agitation & Anxiety
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Recovery, De-Escalation, and Transition of Care in ICU Delirium, Agitation & Anxiety
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Foundational Principles of ICU Delirium, Agitation & Anxiety
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Nausea, Vomiting & Gastrointestinal Symptoms5 Topics|1 Quiz
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Foundational Principles of Nausea, Vomiting & Gastrointestinal Symptoms
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Diagnostic and Classification Criteria for Nausea, Vomiting & Gastrointestinal Symptoms
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Evidence-Based Pharmacotherapy Strategies for Nausea, Vomiting & Gastrointestinal Symptoms
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Supportive Care and Monitoring of Nausea, Vomiting & Gastrointestinal Symptoms
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Facilitating Recovery, Weaning, and Safe Transition of Care
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Foundational Principles of Nausea, Vomiting & Gastrointestinal Symptoms
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Management of Secretions (Death Rattle)5 Topics|1 Quiz
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Foundational Principles and Pathophysiology of Death Rattle
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Diagnostic Evaluation and Classification of Death Rattle
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Pharmacotherapeutic Strategies for Management of Secretions
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Supportive Care and Complication Monitoring in Death Rattle Management
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Therapy De-escalation, Route Conversion, and Transitional Care Planning
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Foundational Principles and Pathophysiology of Death Rattle
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Fluids, Electrolytes, and Nutrition ManagementIntravenous Fluid Therapy and Resuscitation5 Topics|1 Quiz
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Foundational Principles and Pathophysiology of Intravenous Fluid Therapy
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Diagnostic Assessment and Classification of Volume Status
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Evidence-Based Pharmacotherapy in Fluid Resuscitation
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Supportive Care and Complication Management in Fluid Resuscitation
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De-escalation, Transition, and Long-term Recovery Post-Resuscitation
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Foundational Principles and Pathophysiology of Intravenous Fluid Therapy
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Acid–Base Disorders5 Topics|1 Quiz
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Foundational Principles: Pathophysiology, Epidemiology, and Risk Factors
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Diagnostic Assessment and Classification of Acid–Base Disorders
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Pharmacotherapy Strategies for Metabolic and Respiratory Disturbances
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Supportive Care, Ventilation, and Complication Management
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Recovery, De‐Escalation, and Safe Transition of Care
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Foundational Principles: Pathophysiology, Epidemiology, and Risk Factors
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Sodium Homeostasis and Dysnatremias5 Topics|1 Quiz
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Foundational Principles of Sodium Homeostasis and Dysnatremias
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Diagnostic and Classification Framework for Dysnatremias
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Evidence-Based Pharmacotherapy Planning for Sodium Disorders in Critical Care
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Supportive Monitoring and Complication Management during Dysnatremia Correction
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Transition of Care and Recovery Planning after Dysnatremia Management
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Foundational Principles of Sodium Homeostasis and Dysnatremias
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Potassium Disorders5 Topics|1 Quiz
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Foundational Principles of Potassium Disorders: Epidemiology, Pathophysiology, and Risk Factors
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Diagnostic Criteria and Severity Classification in Potassium Disorders
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Evidence-Based Pharmacotherapy for Hypokalemia and Hyperkalemia in Critically Ill Patients
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Supportive Care Measures and Monitoring in the Management of Potassium Disorders
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De-escalation Strategies and Transition of Care in Potassium Disorders
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Foundational Principles of Potassium Disorders: Epidemiology, Pathophysiology, and Risk Factors
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Calcium and Magnesium Abnormalities5 Topics|1 Quiz
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Foundational Principles of Calcium and Magnesium Abnormalities in Critical Illness
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Diagnostic Evaluation and Severity Stratification of Calcium and Magnesium Disorders
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Advanced Pharmacologic Strategies for Calcium and Magnesium Repletion and Removal
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Supportive Care and Monitoring Strategies in Calcium and Magnesium Disorders
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Recovery, Transition of Care, and Long-Term Management of Calcium and Magnesium Abnormalities
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Foundational Principles of Calcium and Magnesium Abnormalities in Critical Illness
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Phosphate and Trace Electrolyte Management5 Topics|1 Quiz
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Foundational Concepts and Epidemiology of Phosphate and Trace Electrolyte Disturbances
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Diagnostics and Classification of Phosphate and Trace Electrolyte Disturbances
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Pharmacotherapy Strategies for Hypo- and Hyperphosphatemia
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Supportive Care and Monitoring in Electrolyte Disturbances
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Recovery, Weaning, and Transition of Care in Electrolyte Management
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Foundational Concepts and Epidemiology of Phosphate and Trace Electrolyte Disturbances
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Enteral Nutrition Support5 Topics|1 Quiz
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Foundational Principles of Enteral Nutrition Support
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Assessment and Classification Criteria for Enteral Nutrition Support
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Designing an Evidence-Based Escalation Plan for Enteral Nutrition Therapy
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Supportive Care and Complication Management in Enteral Nutrition Support
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Weaning, Medication Conversion, and Transition of Care in Enteral Nutrition Support
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Foundational Principles of Enteral Nutrition Support
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Parenteral Nutrition Support5 Topics|1 Quiz
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Foundations of Parenteral Nutrition Support: Epidemiology, Pathophysiology, and Risk Factors
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Diagnostic Evaluation and Risk Stratification in Parenteral Nutrition Support
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Pharmacotherapeutic Planning and Formulation Selection in Parenteral Nutrition Support
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Supportive Care, Complication Prevention, and Goals of Care in Parenteral Nutrition Support
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Weaning, Transition of Nutrition Support, and Post-ICU Continuity in Parenteral Nutrition Support
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Foundations of Parenteral Nutrition Support: Epidemiology, Pathophysiology, and Risk Factors
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Refeeding Syndrome and Specialized Nutrition5 Topics|1 Quiz
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Foundational Principles: Pathophysiology, Epidemiology, and Risk Factors of Refeeding Syndrome
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Diagnosis and Risk Stratification of Refeeding Syndrome
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Pharmacotherapy and Specialized Nutrition Strategies in Refeeding Syndrome
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Supportive Care Measures and ICU Complication Prevention in Refeeding Syndrome
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Recovery, Weaning, and Transition of Care in Refeeding Syndrome
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Foundational Principles: Pathophysiology, Epidemiology, and Risk Factors of Refeeding Syndrome
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Trauma and BurnsInitial Resuscitation and Fluid Management in Trauma5 Topics|1 Quiz
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Foundational Principles, Pathophysiology, and Epidemiology of Trauma-Induced Hypovolemia
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Diagnostics and Classification of Hemorrhagic Shock in Trauma Patients
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Evidence-Based Fluid Selection and Transfusion Strategies in Trauma Resuscitation
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Supportive Care and Management of Complications Post-Resuscitation
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Recovery, De-escalation, and Transition of Care after Initial Resuscitation
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Foundational Principles, Pathophysiology, and Epidemiology of Trauma-Induced Hypovolemia
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Hemorrhagic Shock, Massive Transfusion, and Trauma‐Induced Coagulopathy5 Topics|1 Quiz
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Foundational Principles and Epidemiology of Hemorrhagic Shock and Trauma‐Induced Coagulopathy
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Diagnostics and Classification in Hemorrhagic Shock and Trauma‐Induced Coagulopathy
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Designing an Evidence‐Based, Escalating Pharmacotherapy and Transfusion Plan
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Supportive Care, Monitoring, and Complication Management
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Recovery, De‐Escalation, and Transition of Care after Massive Transfusion
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Foundational Principles and Epidemiology of Hemorrhagic Shock and Trauma‐Induced Coagulopathy
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Burns Pharmacotherapy5 Topics|1 Quiz
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Foundational Principles of Burn Shock Pathophysiology and Hypermetabolism
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Diagnostic Assessment and Classification in Acute Burn Care
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Evidence-Based Pharmacotherapy Strategies for Burn Fluid Resuscitation
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Supportive Care and Monitoring to Prevent and Manage Resuscitation Complications
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Transition to Recovery: Fluid Tapering, Nutritional Transition, and Discharge Planning
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Foundational Principles of Burn Shock Pathophysiology and Hypermetabolism
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Burn Wound Care5 Topics|1 Quiz
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Foundational Principles of Burn Wound Pathophysiology and Risk Factors
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Diagnostic Evaluation and Risk Stratification in Burn Injury and Sepsis
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Pharmacotherapy for Burn Wound Infection Prevention and Sepsis Management
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Supportive Care and Monitoring of Complications in Burn Patients
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Recovery, De-Escalation, and Transition of Care in Burn Patients
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Foundational Principles of Burn Wound Pathophysiology and Risk Factors
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Open Fracture Antibiotics5 Topics|1 Quiz
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Foundational Principles of Infection Risk in Open Fractures
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Diagnostics and Classification of Open Fractures
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Evidence-Based Antibiotic Selection and Dosing for Open Fractures
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Supportive Care and Prevention of Complications in Open Fracture Management
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De-escalation, IV to Oral Conversion, and Transition of Care in Open Fracture Patients
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Foundational Principles of Infection Risk in Open Fractures
Participants 432
Recovery, De‐escalation, and Transition of Care in Hepatic Encephalopathy
Recovery, De-escalation, and Transition of Care in Hepatic Encephalopathy
Learning Objective
- Establish structured protocols for weaning ammonia-lowering therapies, converting to enteral/oral regimens, mitigating post-ICU sequelae, and ensuring safe discharge with outpatient follow-up.
1. Weaning and De-escalation of Ammonia-Lowering Therapies
As mental status stabilizes and precipitating factors are controlled, gradual tapering of lactulose and adjustment of adjuncts minimizes rebound hyperammonemia and gastrointestinal side effects.
Protocol for Tapering Lactulose
- Prerequisite: At least 72 hours of stable mental status (West Haven Grade 0–I) and resolved precipitants.
- Target: Maintain 2–3 soft stools per day. Avoid excessive catharsis which can lead to dehydration and electrolyte imbalances.
- Taper Steps: Reduce the total daily dose by 10–20% every 3–5 days. Ensure remaining doses are split evenly throughout the day.
- Daily Monitoring: Closely track stool frequency and consistency, mental status, and volume/electrolyte status.
- Contingency: If stool count falls below 2 per day or signs of hepatic encephalopathy (HE) recur, revert to the previous effective dose and reassess the patient’s clinical status.
Adjunctive Therapy Adjustment: Rifaximin
- Continue rifaximin 550 mg orally twice daily in patients with a history of two or more HE episodes in the past six months.
- Consider spacing doses (e.g., once daily) only in cases of sustained remission, with close monitoring, and when cost is a significant concern.
- No renal or hepatic dosing adjustment is needed for rifaximin. However, the fluid load from lactulose may require modification in patients undergoing continuous renal replacement therapy (CRRT).
Monitoring for Recurrence During Weaning
- Neurologic Scales: Use the West Haven criteria or Conn score for routine assessment of overt HE.
- Psychometric Tools: Where available, tools like the Inhibitory Control Test can be used to detect minimal HE.
- Ammonia Levels: Avoid routine monitoring of ammonia levels, as they correlate poorly with clinical status during recovery.
- Caregiver Input: Reports from caregivers about subtle changes in behavior, confusion, or the presence of asterixis should trigger an immediate dose reassessment.
Clinical Pearl: Titrate to Stool Output, Not Catharsis +
The primary goal of lactulose therapy is to achieve 2–3 soft stools per day, not maximal catharsis. Over-aggressive dosing leads to dehydration, electrolyte disturbances (hypokalemia, hypernatremia), and patient discomfort, which can paradoxically worsen the clinical picture.
2. Conversion from Intravenous to Enteral/Oral Formulations
Transitioning from intravenous (IV) to enteral/oral therapy is a key step that reduces line-associated infection risks and supports early mobilization and nutrition.
Indications and Timing
- Clinical Stability: The patient should be hemodynamically stable, off vasopressor support, and have an intact, functioning gastrointestinal tract.
- Airway Protection: The patient must be able to protect their airway or have a secured enteral access device in place.
Enteral Access Devices
- Short-term: Nasogastric (NG) or nasojejunal (NJ) tubes are suitable for short-term use.
- Long-term: A percutaneous endoscopic gastrostomy (PEG) tube should be considered if enteral access is anticipated for more than four weeks.
- Administration: Always check tube patency and placement before each medication administration.
Dose Equivalence and Bioavailability
- Lactulose: The enteral dose is generally equivalent to the IV dose (1:1 ratio). However, monitor for increased GI side effects like bloating and cramping upon conversion.
- Rifaximin: Rifaximin does not have an IV formulation. Maintain the standard oral twice-daily dosing schedule once the enteral route is established.
Editor’s Note: Evidence Gap +
Insufficient source material exists for detailed bioavailability data, comparative pharmacokinetic/pharmacodynamic studies, and device-specific administration protocols. A complete clinical guideline would ideally include data on absorption kinetics, medication stability in various feeding formulas, tube-feed compatibility, and stepwise conversion algorithms to ensure therapeutic equivalence.
3. Mitigating Post-ICU Syndrome (PICS)
Critically ill cirrhotic patients are at extremely high risk for PICS, which encompasses delirium, long-term cognitive decline, and functional impairment. Early rehabilitation and bundle-based care are essential to reduce these long-term deficits.
ABCDEF Bundle Components
The ABCDEF bundle is a proven, evidence-based framework for improving ICU patient outcomes:
Cognitive and Functional Rehabilitation
- Initiate occupational and physical therapy (OT/PT) consultations before ICU discharge to establish a baseline and plan for transition.
- Set realistic mobility and Activities of Daily Living (ADL) goals with the patient and family, and monitor progress daily.
Identification and Referral
- Screen high-risk patients, particularly those over age 65 or with prolonged mechanical ventilation (≥7 days).
- Refer patients with identified deficits to neuropsychology or specialized post-ICU clinics for ongoing support after hospital discharge.
Editor’s Note: Implementation Details +
A comprehensive protocol would require more detailed implementation steps, including specific sedation regimens that minimize delirium (e.g., dexmedetomidine over benzodiazepines), standardized mobility checklists for daily goal setting, and metrics for tracking bundle compliance and its impact on patient outcomes.
4. Medication Reconciliation and Discharge Education
A pharmacist-led medication reconciliation process combined with targeted education at transitions of care is critical to reduce medication errors, prevent omissions, and empower patients and caregivers to detect early signs of HE recurrence.
Structured Reconciliation Process
- Verify: Compare the current inpatient regimen against the patient’s pre-admission medication list to identify discrepancies.
- Confirm: Ensure orders for lactulose and rifaximin are correct and clearly written. Actively discontinue any sedatives or analgesics with significant hepatic metabolism (e.g., benzodiazepines, opioids).
- Generate: Create an accurate and easy-to-understand outpatient medication list. Provide prescriptions with bridging supplies as needed to avoid gaps in therapy.
Patient and Caregiver Counseling
- Signs of HE: Teach how to recognize early warning signs like confusion, lethargy, personality changes, and asterixis (hand flapping).
- Therapy Goals: Reinforce the importance of achieving 2-3 soft bowel movements daily and explain how to monitor fluid and electrolyte status.
- Adherence: Emphasize strict adherence to antibiotic regimens (rifaximin) and dietary recommendations.
Health Literacy–Tailored Materials
- Use pictograms, simplified dosing schedules, and large-print materials.
- Employ the teach-back method to confirm understanding of key concepts.
- Provide clear crisis contact information and pathways for when to seek urgent medical attention.
Telehealth Follow-up
Schedule a telehealth follow-up call within 7 days of discharge to review medication adherence, check the patient’s stool diary, and screen for symptoms using a standardized checklist. This allows for early adjustment of the lactulose dose to maintain therapeutic goals and prevent dehydration.
Clinical Pearl: The Power of a Checklist +
Implementing a standardized discharge checklist that includes medications, follow-up appointments, crisis contacts, and patient education confirmation has been shown to halve readmission rates for patients with hepatic encephalopathy.
5. Outpatient Follow-Up and Secondary Prevention
Early and structured outpatient engagement is crucial for identifying minimal HE, optimizing nutrition, and preventing readmission through reinforcement of adherence.
Scheduling Early Visits
- Schedule the first follow-up visit (in-person or telehealth) within 7–14 days post-discharge.
- Coordinate this visit with hepatology, nutrition, and clinical pharmacy services to provide comprehensive care.
Monitoring Minimal Hepatic Encephalopathy (MHE)
- Psychometric Tests: Use validated tools like the Inhibitory Control Test or the paper-based Psychometric Hepatic Encephalopathy Score (PHES) battery.
- Clinical Relevance: Identifying subtle cognitive deficits is critical, as MHE is a major predisposing factor for falls, motor vehicle accidents, and progression to overt HE.
Nutritional and Diet Strategies
- Protein Intake: Target 1.2–1.5 g/kg of ideal body weight per day.
- Energy Intake: Aim for 35–40 kcal/kg of ideal body weight per day.
- Meal Plan: Encourage small, frequent meals and a late-night snack to prevent overnight catabolism. Consider branched-chain amino acid (BCAA) supplements for patients with protein intolerance.
Clinical Pearl: Unmasking Minimal HE +
Early psychometric screening in the outpatient setting can unmask minimal HE in patients who appear clinically normal. This allows for timely therapy re-escalation, targeted patient education, and implementation of fall prevention strategies before a significant adverse event occurs.
6. Quality Metrics and Continuous Improvement
Systematically tracking process and outcome metrics is essential to inform protocol refinement, demonstrate the value of pharmacist-led interventions, and drive continuous quality improvement.
Readmission and Hospitalization Rates
- Primary Outcome: The 30-day HE-related readmission rate is a key performance indicator.
- Benchmarking: Compare institutional performance against published national averages to identify areas for improvement.
Patient-Reported Outcomes and Caregiver Satisfaction
- Use validated quality-of-life (QoL) instruments and satisfaction surveys at follow-up visits.
- Incorporate caregiver burden assessments to understand the full impact of the disease and its management on the family unit.
Protocol Audit and PDSA Cycles
- Audit: Regularly review adherence to key processes, such as discharge checklist completion, timely follow-up scheduling, and delivery of patient education.
- Improve: Use Plan–Do–Study–Act (PDSA) cycles to implement changes based on barrier analysis and feedback from patients, caregivers, and clinicians.
Clinical Pearl: Pharmacist Impact +
Data consistently shows that higher rates of pharmacist-led discharge medication reviews and counseling sessions correlate directly with fewer HE-related readmissions and improved medication adherence at 30 and 90 days.
References
- Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by AASLD and EASL. Hepatology. 2014;60(2):715–735.
- Fallahzadeh MA, Rahimi RS. Hepatic encephalopathy: current and emerging treatment modalities. Clin Gastroenterol Hepatol. 2022;20(S9–S19):S9–S19.
- Bass NM, Mullen KD, Sanyal A, et al. Rifaximin treatment in hepatic encephalopathy. N Engl J Med. 2010;362(12):1071–1081.
- Gerard L, Garey KW, DuPont HL. Rifaximin: a nonabsorbable rifamycin antibiotic for nonsystemic GI infections. Expert Rev Anti Infect Ther. 2005;3(2):201–211.
- Ferenci P, Lockwood A, Mullen K, et al. Hepatic encephalopathy—definition, nomenclature, diagnosis, and quantification. Hepatology. 2002;35(3):716–721.
- Tapper EB, Parikh ND. Inadequate practices for HE management in hospitalized patients: importance of medication reconciliation and patient education. Hepatol Commun. 2022;6(9):xxx–xxx.
- Williams J, Jesudian A. Medication reconciliation in HE management. HCPLive. 2023.
- Bajaj JS, Hafeezullah M, Franco J, et al. Inhibitory control test for diagnosis of minimal HE. Gastroenterology. 2008;135(5):1591–1600.
- Roman E, Córdoba J, Torrens M, et al. Minimal HE is associated with falls. Am J Gastroenterol. 2011;106(3):476–482.
- Amodio P, Bemeur C, Butterworth R, et al. Nutritional management of HE in cirrhosis: ISHEN guidelines. Hepatology. 2013;58(1):325–336.
- Poordad FF. The burden of hepatic encephalopathy. Aliment Pharmacol Ther. 2007;25(Suppl 1):3–9.
- Jesudian A, Williams J. Discharge planning and transition of care in HE. HCPLive. 2023.