Patient with Infection
The specific learning outcomes of this curricular unit (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 severe infection and sepsis (definitions) - L2
2. Stratify the sepsis severity: sepsis (organ dysfunction) and septic shock - L2
3. Recognize and know how to manage organ and/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 and its management - L3
7. Perform microbiological documentation of infection and interpret microbiological results - L3
8. Prescribe empirical and guided antimicrobial therapy, de-escalation and duration - L2
Prof. Doutor Pedro Póvoa
Weekly - Available soon
Total - Available soon
a. The ICU Book. Paul Marino. 4th Edition. Wolters Kluwer/Lippincott Williams & Wilkins, 2014
b. Surgical Intensive Care Medicine. John M. ODonnell and Flávio E. Nácul. 3rd edition. Springer. 2016
c. Arjen M. Dondorp, Martin W. Du¨nser, Marcus J. Schultz (2019). Sepsis Management in Resource-limited Settings. 1st edition. Springer Open. ISBN 978-3-030-03142-8
d. Massimo Sartelli, Matteo Bassetti, Ignacio Martin-Loeches (2018). Abdominal Sepsis. A Multidisciplinary Approach, 1st edition, Springer. ISBN 978-3-319-59703-4
e. Manual do Curso de Evidência na Emergência. António Carneiro. 4ª Edição. Reanima, 2011
f. Manual do Curso de Sepsis e Infecção Grave para Médicos. António Carneiro. 1ª Edição. Reanima, 2011
g. Oxford Textbook of Critical Care. Andrew Webb, Derek Angus, Simon Finfer, Luciano Gattinoni, and Mervyn Singer, 2ª edição. 2016
h. Ivor, B., Griggs, R., Wing, E., & Fitz, J. (2016) Andreoli and Carpenters Cecil Essentials of Medicine. 9th edition. Elsevier Health Sciences. ISBN: 978 -1437718997.
i. Kasper, D., Fauci, A., Hauser, S., Longo, D., Jameson, J., & Loscalzo, J. (2018). Harrisons principles of internal medicine, 20e. ISBN:13: 978-1259644030
j. Surviving Sepsis Campaing (http://www.survivingsepsis.org/Pages/default.aspx)
k. Institute of Healthcare Improvement (http://www.ihi.org/resources/Pages/Tools/SevereSepsisBundles.aspx)
l. Sepsis Alliance (https://www.sepsis.org/)
The CU runs in both semesters with half the students in each semester.
The pedagogical methodology of the CU is of the flipped learning type in which the time of teacher-student contact is used mainly to clarify and systematize concepts/clinical cases/key situations. In each semester, that is in each of the 15 teaching weeks, there will be 2 types of classes:
1. Theoretical classes with an expository nature, with a variable number and duration, using e-learning platforms, to be previewed before the theoretical-practical classes; at least 15 classes with contents related to the topics to be addressed in the theoretical-practical classes or others that the teachers considered pertinent, after evaluation of the UC and the students listened to;
2. Theoretical-practical classes directed to small groups of students (always <15 students) lasting 50 minutes in total of N = 15 (see table below). These classes are always interactive, held in clinical simulation environment with features of real clinical cases and the methodology of problem-solving learning among others. With these classes we intend to train clinical reasoning (fast thinking and slow thinking). The clinical case will be read and presented by the students themselves. Throughout the course of the case, the professor interacts with students asking questions and raising problems, serving as moderator of clinical discussion among students, with the aim of stimulating discussion and clinical reasoning. At each stage of the clinical case will be discussed the differential diagnosis, proposals for diagnostic tests, analysis and interpretation of the results, consulting request other medical/surgical specialties, the treatment plan, which is expected in terms of clinical outcome, the most frequent complications and the prognosis. It is intended that there is maximum interaction in order the student being confronted with the need to take multiple clinical and therapeutic decisions throughout the class.
3. The last class, in addition of being a class of doubts, intends to be a class of team-based learning using a simulator; the class depending on the clinical case will have to perform all the clinical reasoning and approach of the patient.
4. The COVID19 pandemic identified a need for learning by our students - knowledge and practice with personal protective equipment. In each semester, a training course will be organized (before or after one of the semester's classes) with an approximate duration of 15-20 minutes; this training is voluntary but requires prior registration at the CU secretariat until the 4th class of the semester.
Theoretical-practical classes are mandatory. In addition, the respiratory etiquette and social distance rules previously published by NMS | FCM must be complied with; the rooms of the school building of the Hospital de São Francisco Xavier have the appropriate size for the number of students in each class.
Students who miss more than 1/3 of the number of classes taught, will be automatically disapproved to the discipline so they cannot be admitted to the exam.
The assessment consists of a final written exam carried out in person using the MedQUIZZ platform, or alternatively it may have to be carried out remotely using the OneQUIZZ platform, depending on the evolution of the COVID19 pandemic.
Adjustments to this planc could be necessary according to the COVID19 pandemic course.
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 management are to do better with the available tools. The aim of this CU is to systematize the information available to accomplish a better approach of Sepsis, coming from large consensus on the concepts, definitions and proven effective interventions, whenever available. The recent pandemic COVID19 has shown how important it is to have a rational attitude when choosing proven therapeutic interventions and not to treat patients based on momentary inspirations. Learning objectives involve specific skills in medicine and surgery without focusing on specific subjects in these areas. That is, there will be a need to resort on knowledge from several basic medical sciences as well as various clinical areas although not explicitly mentioned. With this approach, we intend to promote clinical reasoning, stimulate the students' intellectual autonomy and develop a holistic view of the practice of medicine, always based on the best and most robust evidence available.
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 2017 and an update in 2018 and 2019, and for COVID19 in 2020). These recommendations, as well as the initiative from the Institute of Healthcare Improvement (IHI), were instrumental to change and structure the management 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. In addition, adaptations of these recommendations have also been made to low- and middle-income countries, with great success.
The syllabus are based on the subjects contained in Despacho n.º 4412/2018 (Diário da República, 2nd series - N.º 86 - May 4, 2018 - Model of the National Access Examination), namely those contained in list in the field Medicine - Infectious area of knowledge (except HIV / AIDS and tuberculosis - discussed in other CU). It should be noted that some of the programmatic contents contained in the aforementioned Despacho will not be specifically addressed (due to time limitation), namely imported malaria and Dengue (endemic in Madeira), since these are two frequent situations in Portugal. Therefore, students will have to prepare them and can clarify any doubts with their teachers. And in the face of pneumonia caused by SARS CoV2 this disease will also be addressed in the community-acquired pneumonia class, as it is a potential cause.
Programs where the course is taught: