0071643192.pdf

COMPLICATIONS

■ Multisystem organ dysfunction
■ Pulmonary failure or adult respiratory distress syndrome (ARDS)

TOXICSHOCKSYNDROME

CAUSES

Inflammatory cascade similar to that seen in sepsis, triggered by exotoxin release

Two distinct syndromes:

Staphylococcal toxic shock syndrome (TSS)

■ Due to colonization with exotoxin-producing strain of Staphylococcus aureus
■ Traditionally associated with tampon use

Streptococcal toxic shock syndrome (STSS)

■ Typically due to infectionwith exotoxin-producing strain of group A strep-
tococcus (GAS)

DIAGNOSIS

■ Based on established clinical criteria (see Table 1.17)

TREATMENT

■ Treatment strategy is the same as for patients with sepsis.
■ Major difference is antibiotic usage to cover MRSA as well as group A
streptococcus.
■ Nafcillin, clindamycin, and vancomycin concomitantly

A 55-year-old male is brought to the ED by EMS after collapsing at

home shortly after sustaining a bee sting to his R hand. On EMS arrival,

the patient is unresponsive and without palpable pulses, but breathing.

IM epinephrine is administered, and patient is rapidly transported to ED. On-

arrival VS: BP 60/40, HR 130s, RR 20. What is the most appropriate first step in

the treatment of this patient?

This patient is in anaphylactic shock with profound hypotension and needs

immediate intravenous epinephrine. Other adjunctive therapies include intra-

venous fluid administration, diphenhydramine, cimetadine, and steroids.

ANAPHYLAXIS ANDANAPHYLACTOIDREACTIONS

Caused by the widespread release of inflammatory mediators, specifically
histamine, leukotriene C4, and prostaglandin D2, leading to widespread
peripheral vasodilation and capillary leakage

PATHOPHYSIOLOGY

■ Anaphylaxis
■ The initial exposure gives rise to IgE antibodies on the surface of mast
cells and basophils.
■ Subsequent exposure results in antigen-antibody binding →cellular
degranulation and widespread release of inflammatory mediators.

RESUSCITATION

TSS results from colonization

with exotoxin-producing

S. aureus.

STSS results from infection

with exotoxin-producing

group A streptococcus.