Septic Storm

[Ronald Gross]

Yup - bacteremia from those very nasty infected wounds.

>>> "Dr Ross Hofmeyr" <wildmedic at gmail.com> 4/18/2008 7:59 AM >>>
I've heard the term used, when I was searching for an answer with a patient
with a similar presentation.  The patient was in the 'High Care' unit of the
hospital where I previously used to work - we didn't have an ICU, but due to
bed pressures in the tertiary hospitals, often managed patients with
ICU-grade acuity in the HCU.  Night cover for the HCU from 2300 to 0700 was
provided by the on-call intern or MO for medicine (depending on which team
was on call), with support from the on-call anaesthetist where necessary.

I was in the hot seat, and called in the small hours to see a patient with
sudden deterioration.  On arrival I found it was a victim of 'community
justice' who had been beaten extensively with a sjambok (traditional whip,
pronounced SHUM-bock) over most of his body.  The sjambok can leave a nasty
open wound, and has been mentioned before on this list, can cause
rhabdomyolysis and 'crush' syndrome.  He was in HCU to maintain a heftily
positive fluid balance and monitor urine output and quality, when he
suddenly (literally from one minute to the next) developed tachycardia,
tachypnoea and rigors.  When I arrived he was shaking vigorously from head
to toe, diaphoretic and distressed, but fully conscious.  At the time he was
apyrexic.  I feared a PE, but there were no suggestive findings.  The
episode lasted a few minutes and then subsided.  Amongst other things, I
drew a blood gas (which was reasonably normal, although I don't recall the
values) and a culture.

A careful examination showed that some of the sjambok wounds (which had been
bandaged on admission) had become infected, and there was some cellulitis in
one area.  I started AB's.   With the patient stabilised, I took no further
action until the morning when I described the incident to the HCU physician,
who was convinced that what we witnessed was a transient bacteraemia,
describing it as a 'septic storm' caused by seeding from one of the wounds
into the bloodstream.

When the blood culture results arrived they were positive for S. aureus.
Usually, S. aureus on a culture makes me suspicious of the technique, but as
I did this one myself in my usual pedantic fashion, I can only conclude the
physician was correct.  The patient went on to recover well, although I have
always remembered the case, and those shakes.

R.

Dr Ross Hofmeyr
Expedition Leader  & Doctor
South African National Antarctic Expedition

> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-
> bounces at trauma.org] On Behalf Of Ronald Gross
> Sent: 18 April 2008 11:27 AM
> To: Critical Care mailing list Trauma &amp
> Subject: Re: Septic Storm
> 
> Charlene,
> 
> Septic storm sounds like a pretty catchy phrase (I kinda wish I thought of
> it!), but this sounds like the garden variety bacteremia to me......septic
> shock, on the other hand, is a whole other story, and I know that you know
> what that is.
> 
> Ron
> 
> >>> "Charlene M Morris" <cvmmorris at gmail.com> 4/18/2008 7:14 AM >>>
> This is a cross post from a PA colleague. if anyone has thoughts or
> explanation for the term "septic storm", please advise!
> 
> Charlene Morris, PA-C
> 
> I have a friend/patient/volunteer EMT who is in the hospital after being
> run
> over by a 30,000# tractor.  He suffered a crushed pelvis.  He has been
> fighting sepsis for some time.  night before last he had a couple of
> episodes of pretty severe shaking.  The nurse used the term "septic storm"
> to his wife to describe these spells.  I could not find any reference to
> thistgerm, either written or internet, nor had my SP ever heard the term.
> the only thing I can conjure up is either the bacteria is releasing waves
> of
> toxin or the antibiotics are causing waves of bacterial cell lysis which
> is
> provoking the episodes.  He did grown out VRE so they have had to change
> antibiotics.  last night he went in to surgery and had a drain placed in
> his
> perineal wound.  It was expected to take 1 hour for the surgery and ended
> up
> taking 3 because they found, drained, cultured and cleaned out an abscess
> pocket, which I figure should help his recovery process.  I realize he is
> not out of the woods by any stretch, but wondered if anyone has heard the
> term "septic storm".  this has hit our small group of 10 volunteer EMTs
> pretty hard  as he and his wife are both EMTs.  His wife is an
> intermediate,
> was first on the scene and managed to hold herself together enough that
> she
> was able to start the two large bore IVs he needed and which   probably
> enabled him to make it through the chopper flight alive.  in any case if
> anyone has heard the term septic shock, I would appreciate hearing what
> you
> understand it means.  TIA.
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