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AMSA Test Prep Corner, in affiliation with the authors of First Aid and USMLERx

Study Timing: How Soon Is Too Soon?
Approach to the Septic Patient
FREE USMLE Step 1 Webinar with Dr. Tao Le
First Aid/USMLE-Rx Fall Special

Study Timing: How Soon Is Too Soon?

There’s one age old question that inevitably creeps into the minds of many medical students during the pre-clinical years:

“When should I start studying for Step 1?”

For a question that seems so universal, the answer is far from it. Here’s a strategy from a student who has been there that may put you in a position to exceed even your own expectations on test day.

Don’t touch any Step 1 review materials throughout your M1 year or the summer between M1 and M2. This hands-off approach so early on may scare a lot of folks who are used to planning more than a few steps (no pun intended) ahead, but your job as an M1 is to build a solid foundation in basic science and physiology that will allow you to make learning pathology as an M2 a worthwhile endeavor.

Once you’re an M2, you’ll be exquisitely aware of the task ahead. That’s the time to kick into high gear as far as preparation for Step 1 goes. Here are some tips:

Fact #1: First Aid for the USMLE Step 1 is your friend. Take the book with you to every lecture and make sure that the topics being covered in class are within the pages of the book. If you notice something in First Aid not touched upon by the professor, make a note to do some thorough textbook reading to get the basics down for review later.

Fact # 2: Every word of First Aid for the USMLE Step 1 is important. Those minute facts that you skim over and dismiss as trivial may rear their heads on the exam.

Fact #3: Questions, questions, questions. The sooner you develop a strategy to attack board style questions, the better off you’ll be. Promise.

As long as you supplement your coursework with First Aid and develop a question approach that works for you, you may not need to start Step 1 studying before your M2 year. After that, it’s up you.

Approach to the Septic Patient

Sepsis is a commonly encountered problem in hospitalized patients that may progress to multi-organ failure, shock, and death if not recognized and treated promptly. In an effort to reduce sepsis-related mortality, the Surviving Sepsis Campaign was initiated in 2002 to establish annual evidence-based guidelines to assist in the early diagnosis and treatment of sepsis. Below are six of the most important diagnostic tests and therapeutic interventions recommended by the Surviving Sepsis Campaign when approaching the septic patient:

1. Check the lactate – lactate is a key diagnostic test when evaluating a septic patient. A product of anaerobic respiration, lactate is a useful indicator of cellular hypoxia and its level correlates strongly with overall prognosis. Additionally, serial lactate levels are very useful in assessing the patient’s response to therapy.

2. Blood cultures before antibiotics – at least two sets of blood cultures (aerobic and anaerobic bottles) should be obtained prior to starting antibiotics, provided that this will not significantly delay their administration (see number 3 below). This is important to facilitate early identification of the causative organism(s) and will direct subsequent antibiotic therapy.

3. Antibiotics within one hour – sepsis is a systemic inflammatory response to an infection, and rapid treatment of the underlying infection with antibiotics is thus of critical importance. Empiric antibiotics for sepsis should have broad coverage of gram-positive, gram-negative, and anaerobic organisms, making vancomycin and piperacillin/tazobactam a common and effective initial choice.

4. Fluids – in patients with severe sepsis and septic shock, the most important initial intervention is administration of fluids to achieve hemodynamic stability. Current guidelines recommend initially giving 30 mL/kg of crystalloid (the internists swear by normal saline while the surgeons swear by lactated ringers, but either is fine!). Colloid solutions such as albumin and fresh frozen plasma are not recommended as first-line fluids for sepsis. Typically, enough fluids should be given to maintain a central venous pressure (CVP) of 8-12 mmHg.

5. Pressors – vasopressors are indicated for septic patients with persistent hypotension despite the initial fluid resuscitation. Norepinephrine (Levophed) is commonly used as the first-line vasopressor for sepsis. Vasopressin is commonly added as a second-line agent for refractory hypotension. Inotropes like dobutamine may be considered for patients with myocardial dysfunction to increase contractility and cardiac output. Pressors should be titrated to maintain a mean arterial pressure (MAP) >65 mmHg.

6. Blood – packed red blood cells should be transfused for septic patients with a hemoglobin concentration <7 g/dL to improve their overall oxygen carrying capacity. Of note, this transfusion threshold may be higher for patients with myocardial ischemia.

FREE USMLE Step 1 Webinar with Dr. Tao Le

We are pleased to announce another high-yield talk from Dr. Tao Le, the series editor for First Aid.

This webinar will cover the basics of the USMLE Step 1 including an overview of the boards, goal setting, high-yield topics in each subject area, study strategies, review resources, and study schedules.

Stay with us after the webinar for a live, interactive Q & A session.

Title: First Aid for the USMLE Step 1 by Dr. Tao Le
Date: Thursday, November 13, 2014
Time: 9:00 PM - 10:00 PM EST

After registering, you will receive a confirmation email containing information about joining the Webinar.

ATTENTION: You can either use your computer's speakers or make a long-distance telephone call to listen to the conference audio.

System Requirements
PC-based attendees
Required: Windows® 8, 7, Vista, XP or 2003 Server

Mac®-based attendees
Required: Mac OS® X 10.6 or newer

Mobile attendees
Required: iPhone®, iPad®, Android™ phone or Android tablet

Space is limited. Reserve your Webinar seat now at:

First Aid/USMLE-Rx Fall Special

Save up to $398 on a Step 1 Triple Play Bundle!

AMSA and USMLE-Rx are excited to bring you an amazing deal on a USMLE-Rx Step 1 Triple Play Bundle. For a limited time, AMSA members can save on a combo that includes USMLE-Rx Step 1 Qmax, First Aid Step 1 Flash Facts, and First Aid Step 1 Express videos!

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Snag a quality review course, question bank, and flash card bundle for hundreds less than you would normally pay! You can lock in your savings today and delay your subscription start by up to 6 months! Learn more at .

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Vol. 7, Issue 1
November 2014


Save BIG on a USMLE-Rx Step 1 Triple Play Bundle

• Step 1 Qmax + First Aid Step 1 Flash Facts + First Aid Step 1 Express

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Triple Play

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