Patient with Infection

Objectives

The specific learning outcomes of this CU, in the 4th year of the curriculum of the MIM, are that the student should be able to, at the end of the semester:

1.       Identify the clinical manifestations of infection and sepsis (definitions) - L2

2.       Stratify the sepsis severity: sepsis, organ dysfunction and septic shock - L2

3.       Recognize and know how to address organ or systems dysfunctions - L2

4.       Perform the different steps to reach hemodynamic stabilization – L2

5.       Distinguish community and hospital-acquired infections - L3

6.       Recognize the major infection foci - L3

7.       Perform the microbiological documentation of infection and interpret microbiological results - L3

8.       Prescribe empirical and guided antibiotic therapy, de-escalation - L2

General characterization

Code

11187

Credits

4

Responsible teacher

Prof. Doutor Pedro Póvoa

Hours

Weekly - Available soon

Total - Available soon

Teaching language

Portuguese

Prerequisites

 

Bibliography

a.       The ICU Book. Paul Marino. 4th Edition. Wolters Kluwer/Lippincott Williams & Wilkins, 2014

b.      Surgical Intensive Care Medicine. John M. O’Donnell and Flávio E. Nácul. 3rd edition. Springer. 2016

c.       Manual do Curso de Evidência na Emergência. António Carneiro. 4ª Edição. Reanima, 2011

d.      Manual do Curso de Sepsis e Infecção Grave para Médicos. António Carneiro. 1ª Edição. Reanima, 2011

e.      Oxford Textbook of Critical Care. Andrew WebbDerek AngusSimon FinferLuciano Gattinoni, and Mervyn Singer, 2ª edição. 2016

Teaching method

The CU runs in both semesters with half the students in each semester.

In each semester, ie, in each one of the 15 teaching weeks, a theoretical-practical class is taught (duration 2 hours). The classes follow the methodology of Problem-Solving Learning and will be taught with the help of media. Students will know in advance what situation or clinical case will be dealt and should prepare each theme in advance. The case will be read and displayed by the students themselves. Along its course the Assistant interacts with the students, asking questions and serving as moderator of the clinical discussion among students, with the role to stimulate discussion and clinical reasoning. At each stage of the clinical case the differential diagnosis, the proposals for additional diagnostic tests, including the request of advice from other medical / surgical specialties, the therapeutic plan, what should be expected from clinical evolution, the more frequent complications and the prognosis will be discussed. A maximum interaction with the students is intended, in order that each one be confronted with the need to take multiple clinical decisions. During the discussion of the clinical case, the data and information taught in previous classes will be discussed again to enrich the discussion and increase the complexity of the situation.

Evaluation method

The methodology of evaluation is done during the semester with a final exam (performed in the MedQUIZZ platform).

Subject matter

A patient with Severe Infection presents a particularly high risk of death. Moreover, in recent years no significant pharmacological development improved its prognosis. Hence, opportunities to improve these patients’ approach are to do better with the available tools. The aim of this CU is to systematize the information available on the correct approach of Sepsis, coming from large consensus on the concepts, definitions and proven effective interventions.

The paradigm shift in the approach of these patients begin with the creation of the Surviving Sepsis Campaign (SSC) and the consensus generated around this important initiative, which was reinforced by the publication of the recommendations SSC 2004, which were successively updated (last publication 2017and an update in 2018). These recommendations, as well as the initiative from the Institute of Healthcare Improvement (IHI), were instrumental to change and structure the approach of sepsis and to systematize procedures. And, at the present time, it is recognized that the implementation of these procedures was responsible for a marked reduction in mortality of these patients worldwide.

Programs

Programs where the course is taught: