6/19/18 Minutes

THE SHELLCOAST CHAPTER OF AACN MINUTES​​​​     JUNE 19, 2018

LOCATION: CANTINA LAREDO

Meeting was called to order by Paul Palanzi, President. Welcome new members Carrie Carty, Susan Hutter and Jayla John.

MEMBERS PRESENT: Nicole Alverio, Karen Bono, Jo Bordoonaro, Susan Cady, Carrie Carty, Diane Corrie, Jan DeBlois, Patricia Hinebaugh, Susan Hutter, Jaya John, Fran Papner, Jacqueline Raffaele, Olinda Spitzer, Ashley Tabor.

NON-MEMBER PRESENT: Domenica Conover.

FUTURE SPEAKERS: The Agenda for the next meetings were discussed. The meeting in July 17th will be sponsored by Medtronic discussing the topic of Capnography. The meeting in September 18th will be sponsored by Zoll about the Live Vest (wearable defibrillators). Above meetings and upcoming meetings will be on-line.

BUSINESS: Paul asked Carrie Carty to share with us her experience in NTI. She enjoyed it very much specially the talk from the nurse from Utah that talked about work place violence. She earned 28 ceu’s. Paul asked who had been to NTI, and who had their CCRN. Paul shared with the members about his experience in NTI and the lunch presentation by a couple that had been in the Boston Marathon. She lost both of her legs and he lost a foot. They wrote a children book and all the attendees received a book signed by the author s donated by AACN. Paul mentioned that Jenneine Lambert went to the Leadership meeting.

New secretary Olinda Spitzer was introduced. Jan DeBlois will continue as Secretary elect. He recognized Diane Corrie for keeping the chapter alive in the past and keeping up with the books.

COMMUNITY SERVICE: Donations made by Susan Hutter for the Salvation Army. All donations are welcome in the next chapter meeting.

AGENDA: REMEMBER THE MAP- CONSIDERATIONS IN DISTRIBUTIVE SHOCK. GIAPREZA (Angiotensin II)                                           BY DANEEN HOLCOMBS, RN, BSN.

Giapreza was approved by the FDA in December 2017 as an adult vaso constrictor to increase blood pressure (MAP) in patients with septic shock or other distributive shock. Septic shock is the most prevalent shock that is costly and increases mortality. There is a new recommendation in the 2018 Update Bundle: 1 hr bundle which includes vasopressor to obtain MAP of 65 mmHg.                                 Daneen explained the 3 pathways to regulate blood pressure as: 1) Catecholamine, 2) Arginine-Vasopressin and 3) Renin-Angiotensin, Aldosterone (this is where Giapreza works).  Giapreza is a synthetic, vasoconstrictor. The study approved by the FDA was ATHOS-3, International, multicenter, double blind study with 344 randomized patients. Primary endpoints of the study: At the end of 3 hours, 70% of the Giapreza patients achieved MAP of 75 mmHg or more than 10 mmHg meanwhile the placebo group only 23% of patients achieved MAP of 75mmHg or more than 10 mmHg. Mortality rate was better with Giapreza.                                                                                                                                                                       Adverse Reactions: Increase thromboembolic events. Give IV thru central Line.                            Contraindications: none. Drug interactions: Angiotensin converting enzyme inhibitors (ACE) may increase response to Giapreza. ARBs may reduce response to Giapreza.

Dosing: Start with 20 nanograms/Kg/min (remember 20ng=0.02mcg). Do not exceed 80 ng/Kg/min during first 3 hours of treatment. Titrate to effect every 5 min by increments up to 15 ng/kg/min. Half- life is less than 1 minute. When discontinuing, titrate down every 5-15 min. increments of up to 15 ng/kg/min based on blood pressure. Eric Askowitz, Critical Care Specialist from La Jolla pharmaceuticals told us the good news. Giapreza was launched in March in this area and Lee health has it in its formulary. The vial costs $1,500.00.  He will start education in Lee Memorial and next few weeks in Health Park.