PROGRAM REGISTRATION FORM Pediatric Tracheostomy Symposium August 28, 2015
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1 PediatricTrachSymposium_Brochure 7/14/15 2:09 PM Page 1 PROGRAM REGISTRATION FORM Pediatric Tracheostomy Symposium Name: Degree: Address: Name of Hospital or Employer: Phone: ( ) Fax: ( ) Specialty: (required for CME) Method of Payment Check for $ enclosed (payable to Methodist Le Bonheur Healthcare) Credit Card: Charge $ to my: American Express MasterCard VISA Discover Credit Card #: CSC #: Exp. Date: Card Holders Name: (Please print) Signature: (Card holder signature) Statement Address: On-line registration available at or mail or fax your completed registration form and fees to: Continuing Medical Education Methodist Le Bonheur Healthcare 251 S. Claybrook, Ste. 512 Memphis, TN (901) Fax: (901) Union Ave. Memphis, Tennessee 38104
2 PEDIATRIC TRACHEOSTOMY SYMPOSIUM DE-BUGGED AND UN-PLUGGED The Urban Child Institute Memphis, Tennessee Overview This seminar has been designed to encompass state-of-the-art practices and trends in treating the pediatric tracheostomy patient. A faculty both clinically and academically oriented will address relevant issues and provide valuable information and insight into situations commonly presented to subspecialists, primary care providers and other healthcare professionals. Objectives Upon completion of this course, the participant should be able to: Select and describe the proper usage of a tracheostomy speaking valve. Describe how to properly maintain and troubleshoot a tracheal airway. Identify the training necessary to prepare families to care for children with trachs. Identify tracheal wound care challenges and select appropriate preventive and treatment options. Describe the rationale and the methods for performing a tracheostomy. Describe medical and community issues experienced by children with tracheostomies and their families. Course Director Professor and Chair of Otolaryngology, Head & Neck Surgery University of Tennessee Health Science Center Memphis, Tennessee Faculty Nancy Burke, RN Nursing Wound Care Noel Frizzell, M.D. General Pediatrics Pediatric Consultants PC Le Bonheur Pediatrics Rhonda Holland, RRT Manager Respiratory Therapy Methodist Alliance Jennifer McLevy, M.D. Pediatric Otolaryngology
3 Molly Pearce, CCLS Child Life Specialist Amy Clair Petro, MS, CCC-SLP Speech Pathologist Jacqueline Butrum-Sullivan, RRT, AE-C Pulmonary Diagnostics Anne Thomas, M.Ed. Educational Administration Friday, 7:45-8:15 a.m. Registration & Welcome Tina Pitt, MPS, RRT-NPS 8:15-9:15 All you ever wanted to know about a tracheostomy, but were afraid to ask. 9:15-10:15 Tracheostomy Speaking Valve Amy Claire Petro, M.S., CCC-SLP 10:15-10:30 Break 10:30-11:30 Care of a Tracheostomy & Trach Emergencies Jennifer McLevy, MD 11:30-12:30 Tracheostomy Education Patient & Family Aspect- Jacqueline Butrum-Sullivan, RRT, AE-C Sibling Aspect Molly Pearce, CCLS Home Care Aspect Rhonda Holland, RRT 12:30-1:30 p.m. Lunch 1:30-2:30 Wound Care Products & Challenge Nancy Burke, RN 2:30-3:30 Surgical Placement 3:30-4:30 The PCP & Family Perspective Noel Frizzell, M.D. & Anne Thomas, M.Ed. 4:30-4:45 Wrap Up & Evaluation Accreditation Methodist Le Bonheur Healthcare is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Methodist Le Bonheur Healthcare is an approved provider of continuing nursing education by the Tennessee Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation.
4 Credit Methodist Le Bonheur Healthcare designates this live activity for a maximum of 7 AMA PRA Category 1 Credit(s). Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity will provide 7 contact hours. Application has been made to the American Association for Respiratory Care (AARC) for continuing education contact hours for respiratory therapists. Faculty Disclosure As a provider accredited by ACCME, Methodist Le Bonheur Healthcare must ensure balance, independence, objectivity and scientific rigor in its educational activities. Course director(s), planning committee, faculty, and all others who are in a position to control the content of this educational activity are required to disclose all relevant financial relationships with any commercial interest related to the subject matter of the educational activity. Safeguards against commercial bias have been put in place. Faculty also will disclose any off-label and/or investigational use of pharmaceuticals or instruments discussed in their presentation. Disclosure of these relevant financial relationships will be published in course materials so those participants in the activity may formulate their own judgments regarding the presentation. Conference Materials Conference materials will be available electronically on August 26, After registering for the conference you will be given a link and password to access the materials. Conference Site The Urban Child Institute 600 Jefferson Avenue Memphis, TN Free parking will be available for conference attendees. Area Attractions Please refer to the web site for a list of Memphis attractions and details. Registration Fees The registration fee is $25.00 for all healthcare providers. This includes one breakfast, one lunch and breaks. Full refund will be given for cancellation notice in writing before August 7, Cancellations after that date will be assessed a fee. No refunds will be given after August 21, Methodist Le Bonheur Healthcare reserves the right to alter, reschedule, or cancel this program should circumstances so dictate. For further information, call (901) or visit
5 PediatricTrachSymposium_Brochure 7/14/15 2:09 PM Page 1 PROGRAM REGISTRATION FORM Pediatric Tracheostomy Symposium Name: Degree: Address: Name of Hospital or Employer: Phone: ( ) Fax: ( ) Specialty: (required for CME) Method of Payment Check for $ enclosed (payable to Methodist Le Bonheur Healthcare) Credit Card: Charge $ to my: American Express MasterCard VISA Discover Credit Card #: CSC #: Exp. Date: Card Holders Name: (Please print) Signature: (Card holder signature) Statement Address: On-line registration available at or mail or fax your completed registration form and fees to: Continuing Medical Education Methodist Le Bonheur Healthcare 251 S. Claybrook, Ste. 512 Memphis, TN (901) Fax: (901) Union Ave. Memphis, Tennessee 38104
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