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For your convenience, find the Trauma List Archive Below

Septic Storm

Robert Simpson r.simpson at clear.net.nz
Sun Apr 20 22:38:09 BST 2008 

Septic Storm is a phrase that I've heard used fairly
frequently in the setting of meningococcal septicaemia. 
Following antibiotic administration, cell wall breakdown
releases large amounts of endotoxin, causing the described
result.  Something for paramedics to be wary of if they are
administering antibiotics in the field, particularly if they
have long trasnport times as the patient tends to get a lot
worse before (if) they get better.

Robbie Simpson

----- Original Message Follows -----
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> Today's Topics:
> 
>    1. Septic Storm (Charlene M Morris)
>    2. Re: Septic Storm (Ronald Gross)
>    3. Re: Septic Storm (Ronald Gross)
>    4. Re: Septic Storm (Charlene M Morris)
>    5. RE: Septic Storm (Dr Ross Hofmeyr)
>    6. Re: Septic Storm (Charlene M Morris)
>    7. Re: Septic Storm (John Annen)
>    8. Re: Septic Storm (Charlene M Morris)
>    9. RE: Septic Storm (Ronald Gross)
>   10. Re: Septic Storm (MARK FORREST)
>   11. ? blunt myocardial injury (joe.nemeth at mcgill.ca)
> 
> 
> ----------------------------------------------------------
> ------------
> 
> Message: 1
> Date: Fri, 18 Apr 2008 07:14:52 -0400
> From: "Charlene M Morris" <cvmmorris at gmail.com>
> Subject: Septic Storm
> To: "Trauma &, Critical Care mailing list"
> <trauma-list at trauma.org> Message-ID:
>    
> <ca095570804180414o547eb49eo6ebaabc20e471c6c at mail.gmail.co
> m> Content-Type: text/plain; charset=ISO-8859-1
> 
> 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.
> 
> 
> ------------------------------
> 
> Message: 2
> Date: Fri, 18 Apr 2008 07:27:29 -0400
> From: "Ronald Gross" <Rgross at harthosp.org>
> Subject: Re: Septic Storm
> To: "Critical Care mailing list Trauma &"
> <trauma-list at trauma.org> Message-ID:
> <48084D61.7FF1.00B9.0 at harthosp.org> Content-Type:
> text/plain; charset=US-ASCII
> 
> 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.
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> 
> 
> ------------------------------
> 
> Message: 3
> Date: Fri, 18 Apr 2008 07:30:28 -0400
> From: "Ronald Gross" <Rgross at harthosp.org>
> Subject: Re: Septic Storm
> To: "Critical Care mailing list Trauma &"
> <trauma-list at trauma.org> Message-ID:
> <48084E14.7FF1.00B9.0 at harthosp.org> Content-Type:
> text/plain; charset=US-ASCII
> 
> By the way, this reminds us all how instinct often takes
> over in a well-trained professional, even in the worst of
> circumstances - and I couldn't imagine something any
> worse!!  Please give this fellow my best wishes - and
> while he and his wife are going through this horror, you
> need to keep reminding her that when her husband recovers,
> he will owe his life to her.  
> 
> >>> "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.
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> 
> 
> ------------------------------
> 
> Message: 4
> Date: Fri, 18 Apr 2008 07:38:37 -0400
> From: "Charlene M Morris" <cvmmorris at gmail.com>
> Subject: Re: Septic Storm
> To: "Trauma &, Critical Care mailing list"
> <trauma-list at trauma.org> Message-ID:
>    
> <ca095570804180438ref78b5cl725ea7cddb0d885b at mail.gmail.com
> > Content-Type: text/plain; charset=ISO-8859-1
> 
> Thank you, Ron!!!!!!!!
> 
> It is heavy on my friend's mind right now.
> 
> Charlene
> 
> On Fri, Apr 18, 2008 at 7:27 AM, Ronald Gross
> <Rgross at harthosp.org> wrote:
> 
> > 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.
> > --
> > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> > --
> > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> 
> 
> ------------------------------
> 
> Message: 5
> Date: Fri, 18 Apr 2008 11:59:14 -0000
> From: "Dr Ross Hofmeyr" <wildmedic at gmail.com>
> Subject: RE: Septic Storm
> To: "'Trauma & Critical Care mailing list'"
>     <trauma-list at trauma.org>
> Message-ID:
> <A402E85A8EF34139B5D15711A384612B at WildMedicPavillion>
> Content-Type: text/plain;    charset="windows-1250"
> 
> 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 &
> > 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.
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> > 
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> > 
> > No virus found in this incoming message.
> > Checked by AVG.
> > Version: 7.5.524 / Virus Database: 269.23.1/1384 -
> > Release Date: 2008/04/17 03:47 PM
> > 
> 
> No virus found in this outgoing message.
> Checked by AVG. 
> Version: 7.5.524 / Virus Database: 269.23.1/1384 - Release
> Date: 2008/04/17 03:47 PM
>  
> 
> 
> 
> ------------------------------
> 
> Message: 6
> Date: Fri, 18 Apr 2008 08:07:26 -0400
> From: "Charlene M Morris" <cvmmorris at gmail.com>
> Subject: Re: Septic Storm
> To: "Trauma &, Critical Care mailing list"
> <trauma-list at trauma.org> Message-ID:
> <ca095570804180507p3c9afda6l65d839df76c72c at mail.gmail.com>
> Content-Type: text/plain; charset=ISO-8859-1
> 
> 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 &
> > > 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.
> > > --
> > > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > > To change your settings or unsubscribe visit:
> > > http://www.trauma.org/index.php?/community/
> > >
> > > --
> > > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > > To change your settings or unsubscribe visit:
> > > http://www.trauma.org/index.php?/community/
> > >
> > > No virus found in this incoming message.
> > > Checked by AVG.
> > > Version: 7.5.524 / Virus Database: 269.23.1/1384 -
> > > Release Date: 2008/04/17 03:47 PM
> > >
> >
> > No virus found in this outgoing message.
> > Checked by AVG.
> > Version: 7.5.524 / Virus Database: 269.23.1/1384 -
> > Release Date: 2008/04/17
> > 03:47 PM
> >
> >
> > --
> > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> 
> 
> ------------------------------
> 
> Message: 7
> Date: Fri, 18 Apr 2008 05:23:00 -0700 (PDT)
> From: John Annen <rjannen at yahoo.com>
> Subject: Re: Septic Storm
> To: "Trauma & Critical Care mailing list"
> <trauma-list at trauma.org> Message-ID:
> <954256.8044.qm at web52904.mail.re2.yahoo.com> Content-Type:
> text/plain; charset=us-ascii
> 
> I like the typo tgerm, for a term about a germ, too. :-)
> 
> John
> 
> ----- Original Message ----
> From: Ronald Gross <Rgross at harthosp.org>
> To: Critical Care mailing list Trauma &
> <trauma-list at trauma.org> Sent: Friday, April 18, 2008
> 1:27:29 PM 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.
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
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> 
> ------------------------------
> 
> Message: 8
> Date: Fri, 18 Apr 2008 08:41:25 -0400
> From: "Charlene M Morris" <cvmmorris at gmail.com>
> Subject: Re: Septic Storm
> To: "Trauma &, Critical Care mailing list"
> <trauma-list at trauma.org> Message-ID:
>    
> <ca095570804180541jad5ddddra7075af306e27a03 at mail.gmail.com
> > Content-Type: text/plain; charset=ISO-8859-1
> 
> what is tgerm?!
> Charlene
> On Fri, Apr 18, 2008 at 8:23 AM, John Annen
> <rjannen at yahoo.com> wrote:
> 
> > I like the typo tgerm, for a term about a germ, too. :-)
> >
> > John
> >
> > ----- Original Message ----
> > From: Ronald Gross <Rgross at harthosp.org>
> > To: Critical Care mailing list Trauma &
> > <trauma-list at trauma.org> Sent: Friday, April 18, 2008
> > 1:27:29 PM 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.
> > --
> > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> > --
> > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> >
> >
> > 
> __________________________________________________________
> > __________________________ Be a better friend, newshound
> > , and know-it-all with Yahoo! Mobile.  Try it now.
> > http://mobile.yahoo.com/
> >  ;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ --
> > trauma-list : TRAUMA.ORG <http://trauma.org/>
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/
> >
> 
> 
> ------------------------------
> 
> Message: 9
> Date: Fri, 18 Apr 2008 08:44:12 -0400
> From: "Ronald Gross" <Rgross at harthosp.org>
> Subject: RE: Septic Storm
> To: "'Trauma & Critical Care mailing list'"
>     <trauma-list at trauma.org>
> Message-ID: <48085F5C.7FF1.00B9.0 at harthosp.org>
> Content-Type: text/plain; charset=US-ASCII
> 
> 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 &
> > 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.
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/ 
> > 
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/index.php?/community/ 
> > 
> > No virus found in this incoming message.
> > Checked by AVG.
> > Version: 7.5.524 / Virus Database: 269.23.1/1384 -
> > Release Date: 2008/04/17 03:47 PM
> > 
> 
> No virus found in this outgoing message.
> Checked by AVG. 
> Version: 7.5.524 / Virus Database: 269.23.1/1384 - Release
> Date: 2008/04/17 03:47 PM
>  
> 
> --
> trauma-list : TRAUMA.ORG
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> http://www.trauma.org/index.php?/community/
> 
> 
> ------------------------------
> 
> Message: 10
> Date: Fri, 18 Apr 2008 19:21:04 +0000 (GMT)
> From: MARK FORREST <atacc.doc at btinternet.com>
> Subject: Re: Septic Storm
> To: "Trauma & Critical Care mailing list"
> <trauma-list at trauma.org> Message-ID:
> <454531.34066.qm at web86305.mail.ird.yahoo.com>
> Content-Type: text/plain; charset=utf-8
> 
> 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.
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
> 
> ------------------------------
> 
> Message: 11
> Date: Tue, 01 Apr 2008 12:35:39 -0400
> From: joe.nemeth at mcgill.ca
> Subject: ? blunt myocardial injury
> To: trauma-list at trauma.org
> Message-ID:
> <20080401123539.dj85e3qm3ows4440 at webmail.mcgill.ca>
> Content-Type: text/plain; charset="iso-8859-1"
> 
> 
> 15 y.o male, prev. healthy...
> Kicked in the chest 8 hours prior to presentation...
> Feeling "funny" since...
> Besides the pulse (180-220/min), all other VS normal...
> Exam non-contributory...
> ECG attached...
> 
> -maybe one prior episode of "palpitations" in the past
> 
> Treatment:
> 
> 1) one of : CCB/BB/Dig
> 2) electrical cardioversion
> 3) Amio
> 4) since pt. stable, wait for peds cardiology to arrive
> approx 2-3  hours...("first, do no harm")
> 5) none of the above
> -------------- next part --------------
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