Program Description :
In this program, the newest technique to monitor tissue oxygenation (StO2) is discussed along with lactate incorporation. Methods of measurement are also presented, illustrating how this non-invasive assessment compares to current techniques, and how it holds the promise of becoming a key monitor on all acute or critically ill patients. Internet links and references are provided to aid the learner after the program is completed
Using research that indicates how learning takes place best, our program is structured to engage the learner, using real life learning skills. Learners fill whatever learning needs they have in our short, targeted classroom videos or learn on their own in our interactive library. Once the learner feels ready to proceed, they enter our virtual reality hospital. The clinical areas are divided into learning/practicing rooms and testing/evaluation rooms.
The program is web based so learning can occur anytime, anywhere. Except for the testing section, the learner can enter and leave the program whenever they want. This allows improved use so the learner can learn at their convenience, either at work or at home.

Program Objective:
The objective of this program is to: Develop the knowledge base of practicing clinicians to recognize current status of patient tissue oxygen and successfully manage patients using StO2 monitoring.

Participant Learning Objectives:
At the completion of this course, the participant will be able to:
1) Describe why StO2 optimization can improve patient outcome.
2) Discuss the limitations of physical assessment and pulse oximetry to assess oxygenation.
3) Explain how StO2 can help identify early signs of loss of blood flow and tissue perfusion.

Learning Rooms -
Each room has a different problem to solve. As the learner enters a room, they must act as they would in real life. The room is interactive, including the patient. If the learner wants information, they must seek the information. As in real life, no information is given without their effort. The learner must make an assessment and if treatment is indicated, administer that treatment. Treatments can be accessed in real life format, e.g. medication carts. Depending on the treatment selected, the patient may get better. Incorrect answers are identified for the learner and suggestions are made to help learning. The learner must solve the problem before being allowed to advance. However, the learner can leave the room if they want and complete the same room at a later time.
Each case is designed to teach specific aspects of care of patients using StO2 monitoring. The key teaching points in each room are identification of normal and abnormal situations and applying the correct treatment to optimize patient care.

Testing Rooms –
in the evaluation section, the hospital room is identical to the learning rooms. However, in these rooms, once the learner has selected a response, no guidelines are given whether the answer is correct or not. The learner chooses to exit the room at any time. Success will be identified by if the learner has completed all the required steps to ensure the patient was adequately treated.
The testing cases involve the most important aspects of pulmonary disturbances and treatment, including potential life threatening situations.

Bibliography / Reference List
1. Cohn SM, Nathens AB, Moore FA, Rhee P, Puyana JC, Moore EE, Beilman GJ; StO2 in Trauma Patients Trial Investigators. Tissue oxygen saturation predicts the development of organ dysfunction during traumatic shock resuscitation. J Trauma 2007; 62(1):44-54.
2. Crookes BA, Cohn SM, Bloch S, Amortegui J, Manning R, Li P, Proctor MS, Hallal A, Blackbourne LH, Benjamin R, Soffer D, Habib F, Schulman CI, Duncan R, Proctor KG. Can near-infrared spectroscopy identify the severity of shock in trauma patients? J Trauma 2005; 58(4):806-13.
3. Ikossi DG, Knudson MM, Morabito DJ, Cohen MJ, Wan JJ, Khaw L, Stewart CJ, Hemphill C, Manley GT Continuous muscle tissue oxygenation in critically injured patients: a prospective observational study. J Trauma 2006; 61(4):780-8.
4. Putnam B, Bricker S, Fedorka P, Zelada J, Shebrain S, Omari B, Bongard F. The correlation of near-infrared spectroscopy with changes in oxygen delivery in a controlled model of altered perfusion. Am Surg 2007; 73(10):1017-22.
5. Skarda DE, Mulier KE, Myers DE, Taylor JH, Beilman GJ. Dynamic near-infrared spectroscopy measurements in patients with severe sepsis. Shock 2007; 27(4):348-53.
6. Soller BR, Idwasi PO, Balaguer J, Levin S, Simsir SA, Vander Salm TJ, Collette H, Heard SO. Noninvasive, near infrared spectroscopic-measured muscle pH and PO2 indicate tissue perfusion for cardiac surgical patients undergoing cardiopulmonary bypass. Crit Care Med 2003; 31(9):2324-31.