According to this article on Medical News Today, a study conducted in the UK revealed that new physicians feel inadequately prepared to care for acutely ill patients. Over the next few weeks, we will be discussing some key acute and critical conditions that future (and current!) physicians should be especially aware of.

One of the most common disorders and most potentially deadly that we see in the Medical ICU is sepsis. Sepsis can occur quickly and, if not recognized and treated swiftly, can kill a patient in a matter of hours. Remember this: A systemic inflammatory response + infection = sepsis. A systemic inflammatory response (SIRS) can occur when there is an insult to the body that causes a cellular reaction that initiates “a number of mediator-induced inflammatory and immune responses” (Gabbard, 2012).

Two or more of the following symptoms indicates a systemic inflammatory response:

In essence, sepsis is basically SIRS caused by an infection or infections – usually gram negative and usually originating in the urinary or respiratory systems. Familiarizing yourself with the pathophysiology of sepsis is of fundamental importance.  It is believed to start with activation of the clotting cascade and RBC abnormality that leads to endothelial injury, mitochondrial dysfunction, vasodilation, and fluid redistribution (Gabbard, 2012). When a patient starts to become agitated and restless, as well as tachypnic, tachycardic and hypotensive, these are classic warning signs of sepsis. If left untreated, this process will progress to severe sepsis and ultimately septic shock, which brings with it a rather grim prognosis.

Proactively speaking, the best way to prevent sepsis from even occurring is by treating the underlying infection which causes the response. However, oftentimes sepsis will worsen regardless. The latest critical care guidelines recommend treatment of septic shock with a “Six hour resuscitation bundle” of broad-spectrum antibiotics, aggressive fluid replacement with normal saline, dobutamine and/or blood transfusions to achieve adequate ScvO2 (which measures the oxygen saturation in venous blood returning to the heart and reflect the balance between oxygen delivery and oxygen consumption), and vasopressors to maintain a mean arterial pressure (MAP) of >65 mm Hg (Gabbard, 2012).

References:

Gabbard, E. (2012). Multisystem. CCRN certification exam review. MedEd. www.MedEdSeminars.net

Rattue, P. (2011).  Newly qualified doctors feel unprepared to look after acutely ill patients, Medical News Today Retrieved from http://www.medicalnewstoday.com/articles/239309.php

2012 is bringing with it changes to the USMLE examination format and content areas, and, whether or not you have already taken a Step (or 2), you may want to familiarize yourself with these changes. A sample of the modification . . .

Six-time limit to pass any USMLE Step (including incomplete attempts).

Effective:

Follow the PASS Program concepts, and you shouldn’t have to take any USMLE Step more than once, much less six times!

Also, according to usmle.org, effective June 17, 2012, the Communication and Interpersonal Skills (CIS) portion of the USMLE Step 2 CS exam has been expanded to assess a wider range of competency (i.e. It will be more extensive) and will focus on five sections:

For more info about the examination changes, and the USMLE, in general, please become familiar with the USMLE Bulletin at ww.usmle.org/bulletin/

The distinction between “bad fats” and “good fats” has received a lot of attention in the public and medical arenas. Generally, we think of saturated fats, trans fats, and Omega-6 fats as “bad” fats, while monounsaturated and Omega-3 fats are considered “good” fats. However, in some instances the distinction is more difficult to make.

One example is Arachidonic acid, an Omega-6 fatty acid present in foods such as red meat, organ meats, and egg yolks. According to an article by Dr. Barry Sears, Understanding (AA) Arachidonic Acid – (Omega 6- Pro Inflammatory Fat), mice injected with pure arachidonic acid die within three minutes.  However, arachidoinic acid, from a clinician’s point of view, is also an essential ingredient in several key bodily functions including healthy skin, blood clotting, and leukotriene and protaglandin synthesis.

Arachidonic acid is an integral part of the pathway to production of lipoxygenase  ultimately leading to production of leukotrienes C4, D4, and E4, which are responsible for bronchoconstriction. However, this pathway also results in the production of leukotriene B4 which is a key component in the inflammatory process that attracts leukocytes to the site of injury.

Arachidonic acid also figures into the cyclooxygenase pathway (COX-1 and COX -2) that produces endopyroxides, prostacyclin and prostaglandin. Endopyroxides are directly related to the production of Thromboxane A2, which serves a primary role in blood clotting. Prostacyclin (PGI2) is pertinent to vasodilation and in decreasing platelet aggregation. Prostaglandins, depending on their type, are responsible for uterine contractions and gastric mucosal protection (E2), or vasoconstriction (F2a). 

So, while you may not want to gulp down Arachidonic acid supplements, or inject yourself with an arachidonic acid serum, this is one Omega-6 acid that your body can’t do without.

Daphne Scott-Henderson, RN, BSN
FNP candidate 2013, Georgetown University

Sears, B., Understanding (AA) Arachidonic Acid-(Omega 6- Pro Inflammatory Fat.  http://www.cbn.com/health/naturalhealth/drsears_arachidonicacid.aspx