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Annual, virtual conference covering sepsis-related topics and offering RN CE Contact Hours
Description
Sepsis Alliance Summit returns for a 6th year this September! This free, virtual 2-day conference features insightful, innovative presentations from a diverse group of experts, including clinicians, researchers, innovators, and key leaders in the field.
FREE Nursing CE Credits Offered!
Continuing nursing education credits will be available, as will post-event access to resources, ideas, and innovations to improve sepsis care. Sepsis Alliance is a Provider approved by the California Board of Registered Nursing, Provider Number CEP17068.
Conference Supporters:
Sepsis Alliance gratefully acknowledges the support provided for this conference by the following sponsors:
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Includes a Live Web Event on 09/17/2025 at 11:00 AM (PDT)
Content provided by Beckman Coulter (No CE credits offered)
Webinar Description:
This sponsored presentation will highlight the crucial role of host response in infection and sepsis management for improved patient outcomes. We will explore the clinical utility of novel biomarkers like MeMed BV (bacterial/viral differentiation) and MDW (early sepsis detection) and discuss strategies to integrate these innovations into routine practice, enhancing diagnostic precision and optimizing care.
No CE credits are offered for this sponsored webinar. Content was determined by the sponsor.
Webinar Sponsor:
Sepsis Alliance gratefully acknowledges the support provided by Beckman Coulter for this sponsored webinar.
Richard Hamilton, MD, MBA, FAAEM, FACEP, FACMT
Professor and Chair, Emergency Medicine
Drexel University College of Medicine
Richard Hamilton, MD, MBA, FAAEM, FACEP, FACMT, is Professor and Chair, Emergency Medicine, Drexel University College of Medicine. He is the Executive Medical Director of Pediatric Emergency Medicine at St Christopher's Hospital for Children. He was formerly the Regional Associate Dean for the Crozer Keystone Campus and EM System Chair of the Crozer Keystone Health System. He is a graduate of the University of Pennsylvania and Hahnemann University College of Medicine. Dr. Hamilton trained at the San Diego Naval Hospital and the Naval Aerospace Medical Institute, completed an EM Residency at the Bronx Municipal Hospital Center / Albert Einstein, and did his Toxicology Fellowship at New York City Poison Control Center / NYU Bellevue.
Dr. Hamilton's research interests include PFAS toxicity, Manganese, water quality, synthetic cannabinoids, MRSA, pharmacology, toxicology, applying game theory to medicine, aerospace medicine, and commercial space travel. He has received awards for his teaching and research and is a widely published author of manuscripts, textbooks, book chapters, and patents.
Dr. Hamilton is a former EM Program Director and has been EM Chair at Drexel University since 2006. He edited the Tarascon Adult Emergency Pocketbook and Tarascon Pocket Pharmacopeia, which was sold in 17 countries and has been translated into Spanish and Japanese. Dr. Hamilton is a Fellow of the American Academy of Emergency Medicine, the American College of Medical Toxicology, the American College of Emergency Physicians, and an Associate Fellow of the Aerospace Medical Association. He is the Past President of the Association of Academic Chairs in Emergency Medicine and the Pennsylvania College of Emergency Physicians. Dr. Hamilton blogs at www.emtoxcast.com and www.thetoxfiles.com.
Melissa Naiman, PhD, EMT-B
Medical Director for Sepsis & Host Response
Beckman Coulter
Melissa Naiman, PhD, EMT-B, is a Medical Director for Beckman Coulter Diagnostics. She trained in chemistry and has a PhD in Public Health with a research interest in technology adoption in healthcare settings. She spent her early career in an academic research center at the University of Illinois that developed medical devices and diagnostics, including identifying novel biomarkers for military health applications. Today she focuses on accelerating innovation in host response-based diagnostic strategies targeting acute infection and sepsis management.
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Includes a Live Web Event on 08/26/2025 at 11:00 AM (PDT)
This webinar explores the groundbreaking international effort to develop a burn-specific framework for early identification, prevention, and management of sepsis.
Description:
Date: August 26, 2025
Time: 2:00 - 3:00 pm ET
Burn-related sepsis presents unique diagnostic and treatment challenges that traditional sepsis protocols fail to address. This webinar explores the groundbreaking international effort to develop a burn-specific framework for early identification, prevention, and management of sepsis. Drawing from expert consensus and the latest evidence, the webinar highlights key distinctions in pathophysiology, the limitations of conventional screening tools, and the development of actionable clinical recommendations designed to improve outcomes in this high-risk population.
Learning Objectives:
At the end of the activity, the learner should be able to:
- Differentiate between the systemic inflammatory response caused by burn injury and true sepsis, using current definitions and diagnostic criteria;
- Identify clinical indicators and evidence-based triggers for initiating sepsis management in burn patients;
- Apply the Surviving Sepsis After Burn Campaign (SSABC) recommendations to guide prevention, diagnosis, and treatment strategies in clinical practice;
- Describe existing protocols for burn sepsis management and identify opportunities for improvement based on SSABC consensus guidelines.
Target Audience:
Nurses, advanced practice providers, physicians, emergency responders, pharmacists, medical technologists, respiratory therapists, physical/occupational therapists, infection prevention specialists, data/quality specialists, and more.
Webinar Supporters:
Sepsis Alliance gratefully acknowledges the support provided for this webinar by the Sepsis Alliance Institute sponsors.
Provider approved by the California Board of Registered Nursing, Provider Number CEP17068 for 1.2 contact hours.
Other healthcare professionals will receive a certificate of attendance for 1 contact hour.
Medical Disclaimer
The information on or available through this site is intended for educational purposes only. Sepsis Alliance does not represent or guarantee that information on or available through this site is applicable to any specific patient’s care or treatment. The educational content on or available through this site does not constitute medical advice from a physician and is not to be used as a substitute for treatment or advice from a practicing physician or other healthcare professional. Sepsis Alliance recommends users consult their physician or healthcare professional regarding any questions about whether the information on or available through this site might apply to their individual treatment or care.
- Differentiate between the systemic inflammatory response caused by burn injury and true sepsis, using current definitions and diagnostic criteria;
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Cytovale Sponsored Webinar: Transforming Sepsis Care: A Nurse-Led Revolution at St. Dominic Hospital
Content provided by Cytovale (No CE credits offered)
Webinar Description:
In this sponsored webinar, discover how IntelliSep is helping redefine sepsis care in the ED by providing a fast, objective, and reliable diagnostic solution that supports early decision-making. Learn how the nursing team at St. Dominic Hospital transformed sepsis response using IntelliSep, leading to greater diagnostic clarity, smoother team communication, improved patient outcomes, and streamlined workflows. Finally, hear a real-world story about a Nurse Practitioner at St. Dominic's who survived sepsis, and how her experience reshaped her clinical practice.
No CE credits are offered for this sponsored webinar. Content was determined by the sponsor.
Webinar Sponsor:
Sepsis Alliance gratefully acknowledges the support provided by Cytovale for this sponsored webinar.
Rhonda Collins, DNP, RN, FAAn
Chief Nursing Officer
Cytovale
Rhonda Collins, DNP, RN, FAAN, is the Chief Nursing Officer at Cytovale and a leader in healthcare innovation. A nurse for over 30 years, she co-founded the American Nurse Project to elevate nurses’ voices.
Previously, she served as Chief Nursing Officer at Vocera, improving clinical communication worldwide. She also held leadership roles at CareFusion, Masimo, and Fresenius Kabi, where she led a medical device through FDA clearance and U.S. launch.
A Fellow of the American Academy of Nursing, Dr. Collins holds degrees from Texas Tech University Health Sciences Center and the University of Texas. A published author and sought-after speaker, she focuses on nursing leadership, cognitive overload, and communication technology in healthcare.
Tracey Smithson, RN, MSN, NEA-BC
Chief Nursing Officer
St. Dominic’s Medical Center
Tracey Smithson, RN, MSN, NEA-BC, is an accomplished healthcare executive with over three decades of clinical and leadership experience. As Vice President and Chief Nursing Officer at St. Dominic’s Medical Center, she provides strategic and clinical oversight for a multi-campus system encompassing 5,000 staff and 565 beds, including a comprehensive stroke center, a level III trauma emergency department, and the Mississippi Heart & Vascular Institute.
Tracey has a proven track record of improving clinical outcomes, streamlining operations, and leading major accreditations and redesignations across multiple facilities. She is a sought-after speaker and thought leader, recognized as one of Dallas-Fort Worth’s Great 100 Nurses and a Leader of the Year at Medical City North Hills. Tracey serves on the board of the Mississippi Heart and Vascular Institute and remains an active voice in advancing nursing excellence and healthcare delivery across the Southeast.
Dan Woods, MSN, RN
Senior Director of Emergency Services and Hospital Throughput
St. Dominic’s Medical Center
Dan Woods, MSN, RN, is a dynamic healthcare executive with clinical roots and a decade of progressive leadership experience. As Senior Director of Emergency Services and Hospital Throughput for St. Dominic Health within Franciscan Missionaries of Our Lady Health System, he leads patient flow and acute care transfer strategies across a multi-hospital network serving thousands of patients across the Gulf South.
Dan has led enterprise initiatives including the development of centralized transfer and logistics centers, large-scale ED expansions, community crises, and EHR transitions, all aimed at improving throughput, resource utilization, and care delivery across the continuum. His work is grounded in data, frontline collaboration, and real-time operational responsiveness.
A frequent speaker on operational excellence, he has been honored as the Catholic Health Association’s Tomorrow’s Leader and one of Mississippi’s Emerging Leaders. Committed to developing future talent, Dan mentors through the ACHE mentoring program and serves on the board of the Greater Jackson Chamber of Commerce, helping shape the future of care delivery and workforce development.
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Register for this if you plan to claim CE credits for 3+ podcast episodes.
Description:
This package includes the CE evaluations and CE credits for each individual podcast episode. You can register for the individual episode evaluations if you plan to complete fewer than three.
Forget everything you ever read in a textbook when it comes to antimicrobial resistance (AMR) and sepsis complications – because they rarely play by the rules. They evolve, adapt, and strike before it’s too late. While classic symptoms like fever, tachycardia, and hypotension are well known, the real challenge lies in recognizing the unexpected to reduce your mental list of those unknown, unknowns.
Hosted by Critical Care RN & CNS Author Nicole Kupchik, The Sepsis Spectrum is an exploration of real-world patient cases, expert insights, and clinical deep dives to unravel the most complex presentations facing modern medicine. Through gripping stories and in-depth interviews, Nicole examines diagnostic challenges, cutting-edge treatments, and the growing threat of AMR.
Designed for healthcare professionals at every level, The Sepsis Spectrum is about leaving you with more than compelling stories—it’s a vital resource in podcast form. Whether you’re at the bedside or in the classroom, you’ll finish each episode with practical, life-saving knowledge—and earn free CE Contact Hours for nurses along the way.
The fight against sepsis and AMR starts with recognition — because the most dangerous threats are the ones you don’t see coming.
Learning Objectives:
At the end of the series, the learner should be able to:
- Identify the public health threat posed by antimicrobial resistance (AMR) and describe the relationship between infection prevention, AMR, and sepsis;
- Assess the interconnections between humans, animals, and the environment in relation to AMR and sepsis;
- Apply recommendations for recognizing, diagnosing, and treating AMR and sepsis in outpatient and pre-hospital settings;
- Analyze the consequences of healthcare-acquired infections involving multi-drug-resistant organisms and discuss strategies for their prevention;
- Describe the importance of multi-disciplinary collaboration among infection prevention, antimicrobial stewardship, and sepsis teams in enhancing early detection, appropriate treatment, and improved outcomes in infectious disease management;
- Explore innovations in AMR and sepsis diagnostics and treatments, with a focus on how they aim to personalize patient care;
- Evaluate how quality improvement and patient safety practices address healthcare-acquired infections, multidrug-resistant organisms, and sepsis;
- Implement best practices for care coordination and transitions of care discharge planning, with an emphasis on AMR and antimicrobial stewardship in post-sepsis patient care;
- Consider specific care needs and best practices for managing AMR and sepsis in specialty populations, including pediatric, maternal, and immunocompromised patients.
Target audience:
All healthcare professionals and healthcare students including nurses, physicians, advanced practice providers, pharmacists, infectious disease and prevention specialists, scientists, and researchers, sepsis coordinators, sepsis data & quality professionals, healthcare executives and leadership, nursing and medical school deans & faculty, professional healthcare organizations, healthcare advocates, government, and industry.
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Content provided by FIZE Medical (No CE credits offered)
Webinar Description:
Join top critical care experts in this FIZE Medical-sponsored webinar for a fresh look at managing unstable ICU patients using available biomarkers and real-time metrics. This webinar will cover the latest on sepsis, acute kidney injury (AKI), and hemodynamic management. Attendees will leave with a better understanding of how smarter data can drive faster, more targeted decisions when every second counts in the ICU.
No CE credits are offered for this sponsored webinar. Content was determined by the sponsor.
Webinar Sponsor:
Sepsis Alliance gratefully acknowledges the support provided by FIZE Medical for this sponsored webinar.
Joseph Carcillo, MD
Professor of Critical Care Medicine and Pediatrics
University of Pittsburgh, Department of Critical Care Medicine
Joseph Carcillo, MD, specializes in pediatric critical care medicine and pediatrics. He is certified by the American Board of Pediatrics and affiliated with UPMC Horizon, UPMC Mercy, UPMC Children's Hospital of Pittsburgh, UPMC Altoona, and UPMC Northwest. He completed his medical degree at George Washington University Medical Center, along with a residency and fellowship at Children's National Medical Center. He was previously Taskforce Chair of the ACCM Guidelines for Hemodynamic Support of Newborn and Pediatric Septic Shock, and a member of the Centers for Disease Control and Prevention (CDC) Taskforce for Definitions of Pediatric Sepsis.
Ravindra L. Mehta, MD, FACP, FRCP
Program Director - Associate Chair for Clinical Medicine, Department of Medicine
UC San Diego School of Medicine
Ravindra Mehta, MD, FACP, FRCP, is a Professor Emeritus of Medicine at the University of California San Diego where he directs the UCSD Master of Advanced Studies in Clinical Research program and is the site Principal Investigator of the NIH-funded UAB/UCSD O’Brien Center for AKI research. He chairs the annual International AKI and CRRT Conference in San Diego. Dr. Mehta is a founding member of the Acute Dialysis Quality Initiative (ADQI) and the Acute Kidney Injury Network (AKIN). His research has informed >span class="NormalTextRun SCXW217165272 BCX0"> development of the KDIGO guidelines for AKI. He has spearheaded several innovative multicenter studies on AKI including the International Society of Nephrology (ISN) AKI 0by25 project.
In 2008 Dr. Mehta was recognized by the American Nephrologists of Indian Origin and in March 2009 he was elected as a Fellow of the Royal College of Physicians in the UK. He received the ISN Bywaters Award for lifetime achievement in AKI in 2011 and in 2020 the ISN honored him by establishing a fellowship in AKI in his name.
He received the M.B.B.S. degree (1976) from the Government Medical School in Amritsar, India, and the M.D. (1979) and D.M. (1981) degrees from the Post Graduate Institute of Medical Education and Research in Chandigarh, India. He obtained his boards in Internal Medicine (1986) and Nephrology (1988) at the University of Rochester in Rochester New York. He has been on the faculty at UC San Diego since 1988.
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This session explores the most severe forms of sepsis affecting pregnant and postpartum individuals in the U.S.
Description:
Date: May 14, 2025
Time: 2:00 - 3:00 pm ET / 11:00 am - 12:00 pm PT
Maternal Sepsis Week highlights the urgency of addressing perinatal sepsis, a leading cause of maternal morbidity and mortality. This session explores the most severe forms of sepsis affecting pregnant and postpartum individuals in the U.S., examining their connection to emerging infectious threats. Current treatment guidelines will be applied to critical care scenarios, assessing the effectiveness of different management strategies. The session also focuses on proactive approaches to early detection and intervention, particularly during disease outbreaks, to improve patient outcomes and reduce complications.
Learning Objectives:
At the end of the activity, the learner should be able to:
- Describe the severe forms of sepsis affecting pregnant women in the US;
- Explain the relationship of severe forms of sepsis to rising endemic and pandemic diseases;
- Apply current treatment guidelines to manage cases of critical perinatal sepsis;
- Analyze the effectiveness of different treatment strategies for perinatal sepsis.
Target Audience:
Nurses, advanced practice providers, physicians, emergency responders, pharmacists, medical technologists, respiratory therapists, physical/occupational therapists, infection prevention specialists, data/quality specialists, and more.
Jason Vaught, MD
Associate Professor of Gynecology and Obstetrics
Johns Hopkins University School of Medicine
Jason Vaught, MD, is an Associate Professor of Gynecology and Obstetrics, and Surgery at the Johns Hopkins Hospital where he serves as a maternal fetal medicine and critical care specialist. His research studies and clinical expertise include maternal critical illness, cardiac disease in pregnancy, hypertensive disorders of pregnancy, and placenta accreta spectrum.
He has been active in the care of both pregnant and non-pregnant patients within the COVID pandemic. He also serves as the Director of Labor and Delivery at Johns Hopkins Hospital.
Provider approved by the California Board of Registered Nursing, Provider Number CEP17068 for 1.2 contact hours.
Other healthcare professionals will receive a certificate of attendance for 1.0 contact hour.
Medical Disclaimer
The information on or available through this site is intended for educational purposes only. Sepsis Alliance does not represent or guarantee that information on or available through this site is applicable to any specific patient’s care or treatment. The educational content on or available through this site does not constitute medical advice from a physician and is not to be used as a substitute for treatment or advice from a practicing physician or other healthcare professional. Sepsis Alliance recommends users consult their physician or healthcare professional regarding any questions about whether the information on or available through this site might apply to their individual treatment or care.
- Describe the severe forms of sepsis affecting pregnant women in the US;
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Virtual, one-day conference covering a variety of topics in antimicrobial resistance and stewardship
Description
Wednesday, April 30, 2025
According to a 2023 Sepsis Alliance survey, 85% of C-Suite executives in healthcare are concerned that antimicrobial resistance (AMR) may be increasing the potential of another pandemic. Are you ready to fight back?
Designed to explore cutting-edge solutions for antimicrobial resistance (AMR) in healthcare, the 2025 Sepsis Alliance AMR Conference provides a unique opportunity for clinicians, caregivers, patients, and the public to gain practical knowledge from experts and explore innovative approaches for combating AMR. Collaborative effort across sectors, ongoing innovation, and educational initiatives are essential to manage this intricate clinical interplay and tackle the global AMR threat.
As AMR intensifies, the risk of infections progressing to sepsis rises, leading to more challenging cases and adverse outcomes like amputations and fatalities.
We encourage you to attend sessions live, as speakers will be present to answer questions for most sessions. If you cannot attend live, sessions will be available at a later date.
FREE Nursing CE Credits Offered!
Continuing nursing education credits will be available, as will post-event access to resources, ideas, and innovations to improve antimicrobial stewardship. Sepsis Alliance is a Provider approved by the California Board of Registered Nursing, Provider Number CEP17068.
Conference Supporters:
Sepsis Alliance gratefully acknowledges the support provided for this conference by the following sponsors:
Please feel free to download, print, display, or share the flyer linked below. It contains a QR code that can be used to register for this conference.
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New!
A multi-part sepsis foundational curriculum designed to establish a strong knowledge of key sepsis concepts for nurses and other healthcare professionals
Description:
Sepsis remains the leading cause of death in U.S. hospitals. Rapid recognition and response are critical to improving sepsis survival rates. Research highlights the need for increased sepsis education among healthcare professionals, as targeted training has been shown to enhance recognition accuracy and reduce time to diagnosis across various patient populations. Sepsis Alliance Presents: Sepsis Fundamentals, a multi-part sepsis foundational curriculum designed to establish a strong knowledge of key sepsis concepts for nurses and other healthcare professionals, including sepsis coordinators, is designed to address this gap. This course serves as a foundation for more specialized sepsis training, ultimately contributing to improved patient outcomes.
Learning Objectives:
At the end of the Sepsis Fundamentals course, the learner should be able to:
- Describe the epidemiology of sepsis, including its prevalence, risk factors, and impact on patient outcomes;
- Recognize the early signs and symptoms of sepsis across different patient populations using clinical assessment tools;
- Differentiate sepsis from other conditions by interpreting diagnostic criteria, laboratory findings, and clinical presentations;
- Implement evidence-based treatment protocols for sepsis management, including fluid resuscitation, antimicrobial therapy, and supportive care;
- Support patient recovery by identifying post-sepsis syndrome symptoms and recommending appropriate follow-up care and rehabilitation strategies; Evaluate strategies for sepsis quality improvement and patient safety, including protocol adherence, early warning systems, and multidisciplinary teamwork.
Target Audience:
Nurses, advanced practice providers, physicians, emergency responders, pharmacists, medical technologists, respiratory therapists, physical/occupational therapists, infection prevention specialists, data/quality specialists, and more.
Sepsis Alliance gratefully acknowledges Baxter for their support for the Sepsis Fundamentals program.
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Recorded On: 04/23/2025
Learn the latest definitions, epidemiology, diagnostic advancements, and treatment protocols for pediatric sepsis.
Description:
Date: April 23, 2025
Time: 2:00 - 3:00 pm ET
Each day, over 200 pediatric cases of severe sepsis are diagnosed in the U.S., and an average of 18 children hospitalized with sepsis die. Additionally, sepsis is missed in up to 8% of children presenting to emergency departments. During this year's Pediatric Sepsis Week (April 20-26, 2025), one of the nation’s leading sepsis experts will provide an in-depth presentation on pediatric sepsis. Dr. Zimmerman will cover the latest sepsis definitions, epidemiology, and pathophysiology for pediatrics. Learners will also explore novel diagnostic advancements, sepsis treatment bundle protocols, and long-term patient outcomes.
Learning Objectives:
At the end of the activity, the learner should be able to:
- Describe the contemporary definition of sepsis;
- Recall pediatric sepsis epidemiology;
- List novel sepsis diagnostic modalities;
- Summarize sepsis pathophysiology;
- Define sepsis bundled treatment protocols;
- State long-term sepsis mortality and morbidity.
Target Audience:
Nurses, advanced practice providers, physicians, emergency responders, pharmacists, medical technologists, respiratory therapists, physical/occupational therapists, infection prevention specialists, data/quality specialists, and more.
Jerry J. Zimmerman, MD, PhD, MCCM
Faculty, Pediatric Critical Care Medicine
Seattle Children's Hospital; Harborview Medical Center University of Washington, School of Medicine
Jerry J. Zimmerman, MD, PhD, MCCM, is a Professor of Pediatrics and Anesthesiology and a senior faculty member in the Division of Pediatric Critical Care Medicine (PCCM) at Seattle Children’s Hospital and Harborview Medical Center, University of Washington School of Medicine. A leader in pediatric critical care research, he has served on numerous national committees dedicated to advancing the field. As co-editor of Pediatric Critical Care, now in its seventh edition, he brings deep expertise in PCCM’s academic landscape.
Dr. Zimmerman has been engaged in sepsis research for over 30 years, earning international recognition for his contributions. He was an inaugural satellite site principal investigator for both the Collaborative Pediatric Critical Care Research Network (CPCCRN) and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Recently, he chaired the Society of Critical Care Medicine’s (SCCM) Discovery Research Network.
His research leadership includes serving as principal investigator for the Life After Pediatric Sepsis Evaluation (LAPSE) study (NCT01415180), which examined long-term outcomes of children with septic shock. He also led the Genotypes and Phenotypes in Pediatric SIRS and Sepsis (GAPPSS) study, evaluating the diagnostic potential of gene mRNA expression signatures (SeptiCyte™) and proteomics in distinguishing bacterial sepsis, severe viral illness, and non-infectious systemic inflammation in critically ill children.
Dr. Zimmerman played a key role in the international PODIUM collaborative, which established modern definitions for single and multiple organ dysfunctions, and led SCCM’s Taskforce in defining the Phoenix Pediatric Sepsis Definition. He is currently a co-principal investigator for the Stress Dose Hydrocortisone in Pediatric Septic Shock (SHIPSS) interventional trial (NCT03401398). A past president of SCCM, Dr. Zimmerman has been honored with distinguished service awards from both SCCM and the American Academy of Pediatrics' Critical Care Section.
Provider approved by the California Board of Registered Nursing, Provider Number CEP17068 for 1.2 contact hours.
Other healthcare professionals will receive a certificate of attendance for 1 contact hour.
Medical Disclaimer
The information on or available through this site is intended for educational purposes only. Sepsis Alliance does not represent or guarantee that information on or available through this site is applicable to any specific patient’s care or treatment. The educational content on or available through this site does not constitute medical advice from a physician and is not to be used as a substitute for treatment or advice from a practicing physician or other healthcare professional. Sepsis Alliance recommends users consult their physician or healthcare professional regarding any questions about whether the information on or available through this site might apply to their individual treatment or care.