toxic shock syndrome: the challenge - acoep · 2. describe the presentation of toxic shock...
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Toxic Shock Syndrome: The Challenge
Brit Long, MD, FACEP @long_brit
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Disclosures
I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in this CME activity.
I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.
The views expressed in this lecture do not reflect the views or opinions of the U.S. government, Department of Defense, U.S. Army, U.S. Air Force, Brooke Army Medical Center, or SAUSHEC EM Residency Program.
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Objectives
1. Understand the causes and associations of toxic shock syndrome.
2. Describe the presentation of toxic shock syndrome.
3. Describe the diagnostic challenges of toxic shock and the faults of using the classic criteria.
4. Develop a plan for when to consider the diagnosis.
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1. TSS - 2 major causes: Staph and Strep2. TSS is a difficult diagnosis –
• Severe, systemic illness with…• Diffuse, blanchable, red rash• Young patient with shock and viral illness• Focal infection with POOP• Severe group A strep infection• Vital signs OOP to degree of infection
3. Do not rely on classic criteria4. Suspect => Treat first, diagnose later
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Staph Strep
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Staph Strep
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Staph
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Strep
vs.
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Strep50% of necrotizing
fasciitis cases caused by Strep are
associated with TSS
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Labs…
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Rash
Fever
Desquamation*
Hypotension
Multiorgan Failure
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“Once the full range of symptoms become manifest, the diagnosis is usually straightforward. However, the patient may have developed irreversible organ failure by the time this occurs.”– Murray 2005
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•Suspicion! • Severe, systemic
illness with…• Diffuse, blanchable, red
rash• Young patient with shock
and viral illness• Focal infection with
POOP• Group A strep infection• Vital signs OOP to degree
of infection
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•If present •Source control•Antibiotics• IV resuscitation• ICU admission• IVIG?
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1. TSS - 2 major causes: Staph and Strep2. TSS is a difficult diagnosis –
• Severe, systemic illness with…• Diffuse, blanchable, red rash• Young patient with shock and viral illness• Focal infection with POOP• Severe group A strep infection• Vital signs OOP to degree of infection
3. Do not rely on classic criteria4. Suspect => Treat first, diagnose later
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@long_brit