List Archives

Tue Apr 22 15:46:38 BST 2008

Hi All:
Never heard that termology before (septic storm). It sounds like your  
friend most likely experienced a compartment syndrome injury after  
that much weight, which then developed into a abcess like appearance.  
He most likely developed DIC which gives the showering type of  
petechiae.
Carol RN,BSN

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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 &amp, Critical Care mailing list" <trauma-list at trauma.org>
> Message-ID:
> 	<ca095570804180414o547eb49eo6ebaabc20e471c6c at mail.gmail.com>
> 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 &amp" <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 &amp" <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 &amp, 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 &amp; 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 &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.
>> --
>> 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 &amp, 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 &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.
>> > --
>> > 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 &amp; 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
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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 &amp, 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/
>>
>> --
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>>
>>
>>
>>    
>> ____________________________________________________________________________________
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>
>
> ------------------------------
>
> Message: 9
> Date: Fri, 18 Apr 2008 08:44:12 -0400
> From: "Ronald Gross" <Rgross at harthosp.org>
> Subject: RE: Septic Storm
> To: "'Trauma &amp; 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 &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.
>> --
>> 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/
>>
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>> Checked by AVG.
>> Version: 7.5.524 / Virus Database: 269.23.1/1384 - Release Date:
>> 2008/04/17 03:47 PM
>>
>
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>
> ------------------------------
>
> 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 &amp; 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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>
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