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Fri Apr 18 20:21:04 BST 2008

HI Charlene
What you describe is commonly recognised in hospital surgical and critical care practice. Patients with an infected area or a collection of pus can produce episodes of instability, fever, rigors and septic shock. We often describe it as 'transient bacteraemia' and results from criculation of bacteria and their toxins.

Any patient having these episodes must be throughly worked up for a source. In your friend the pelvis would always be high on the list, especially if a compound wound or contaminated by disruption of the pelvic structures. You confirm this fact when you describe your colleague having an unexpected pus collection or abscess when he went to surgery. Hopefully, now that this is drained he will start to improve and I wish him and his courageous wife all the very best.

Incidentally, just one question, was the pelvis strapped and how has it been managed since then?

Best wishes
Mark F
UK

Dr Mark Forrest
Consultant in Anaesthetics & Critical Care
Medical Director of Cheshire Fire & Rescue Service
Medical Director of ATACC

----- Original Message ----
From: Charlene M Morris <cvmmorris at gmail.com>
To: "Trauma &, Critical Care mailing list" <trauma-list at trauma.org>
Sent: Friday, 18 April, 2008 12:14:52 PM
Subject: Septic Storm

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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Septic Storm