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Fri Apr 18 13:07:26 BST 2008

very nice, doc!! thank you.

Charlene

On Fri, Apr 18, 2008 at 7:59 AM, Dr Ross Hofmeyr <wildmedic at gmail.com>
wrote:

> 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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