Anesthesiology's journal-based CME program is open to all readers. Members of the American Society of Anesthesiologists participate at a preferred rate, but you need not be an ASA member or a journal subscriber to take part in this CME activity. Please complete the following steps:

  1. Read the article by Brunkhorst et al. entitled “Protein C concentrations correlate with organ dysfunction and predict outcome independent of the presence of sepsis” on page 15 and the accompanying editorial by Gropper entitled “Multisystem organ failure: Predicting the future” on page 6 of this issue.

  2. Review the questions and other required information for CME program completion (published in both the print and online journal).

  3. When ready, go to the CME Web site: http://www.asahq.org/journal-cme. Submit your answers, form of payment, and other required information by December 31 of the year following the year of publication.

The American Society of Anesthesiologists is approved by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education programs for physicians.

The American Society of Anesthesiologists designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Purpose: The focus of the journal-based CME program, and the articles chosen for the program, is to educate readers on current developments in the science and clinical practice of the specialty of Anesthesiology.

Target Audience: Physicians and other medical professionals whose medical specialty is the practice of anesthesia.

Learning Objectives: After reading this article, participants should have a better understanding of the pathophysiology of multisystem organ failure and the role(s) of protein C.

Disclosure Information:

Authors – Frank Brunkhorst, M.D., Yasser Sakr, M.B., B.Ch., M.Sc., Stefan Hagel, M.D., and Konrad Reinhart, M.D.

Grants or research support: Supported by competitive, peer-reviewed grants from the Thuringian Ministry of Science, Thueringen, Germany.

Consultantships or honoraria: None

Authors – Michael A. Gropper, M.D., Ph.D.

Grants or research support: None

Consultantships or honoraria: None

The article authored by Dr. Gropper was supported solely from institutional and/or departmental sources.

Question Writers – Peter L. Bailey, M.D., and Leslie C. Jameson, M.D.

Drs. Bailey and Jameson have no grants, research support, or consultant positions, nor do they receive any honoraria from outside sources, which may create conflicts of interest concerning this CME program.

Article Questions

Based on the article by Brunkhorst et al. entitled “Protein C concentrations correlate with organ dysfunction and predict outcome independent of the presence of sepsis” http://content.wkhealth.com/linkback/openurl/trusted?issn=0003-3022&volume=107&issue=1&spage=6&part=fulltext and its accompanying editorial by Gropper entitled “Multisystem organ failure: Predicting the future” http://content.wkhealth.com/linkback/openurl/trusted?issn=0003-3022&volume=107&issue=1&spage=15&part=fulltext in the July issue of Anesthesiology, choose the one correct answer for each question:

1. Which of the following is most likely to lead to multiple organ system failure?

A. Trauma

B. Pancreatitis

C. Burns

D. Sepsis

2. Which of the following most likely occurs in multiple organ system failure?

A. Reduced proinflammatory proteins

B. Increased microvascular blood flow

C. Increased fibrin thrombus in organ capillary beds

D. Decreased binding of neutrophils to injured tissue

3. Which of the following statements concerning protein C is most likely true?

A. Recombinant human activated protein C is not approved by the Food and Drug Administration.

B. Protein C normally circulates as an inactive zymogen.

C. Activated protein C enhances the actions of thrombin.

D. Activated protein C increases thrombus formation in the microcirculation.

4. Which of the following statements concerning surgical intensive care unit (ICU) patients and protein C is most likely true?

A. Protein C concentrations are usually elevated upon admission.

B. Protein C concentrations correlate with the degree of organ dysfunction.

C. Protein C concentrations do not predict mortality.

D. Peak protein C concentrations occur a few days after ICU admission.

5. Patients in which of the following surgical groups are most likely to have preserved protein C concentrations during their intensive care unit stay after surgery?

A. Neurosurgery

B. Cardiothoracic surgery

C. Vascular surgery

D. Trauma