Sepsis in the Trauma Patient

Recently, we received a telemetry call that a patient who had been "found
down" would be brought in and per EMS, although they had been called for
"shortness of breath" she apparently had a tibia fracture. One´s mind
drifts to fatty embolus, tibial plateaus, the popliteal vessels... Except
there was no tibia fracture. In fact, there was no traumatic injury at all.
Only a patient who we quickly recognized was in shock, likely of septic
origin. Four liters of IV fluid she was still hypotensive and tachycardic,
with 11 platelets, a creatinine of 8 and a CK of 3000. She got antibiotics,
a central line, an arterial line, an ETT and a CT scan that revealed what
was likely endocarditis. And then she got admitted to the MICU...



This was clearly not a trauma patient, and we managed her with Early Goal
Directed Therapy in mind. Although there has recently been some debate
about EGDT, the reliability of CVP, and Manny Rivers´ conflicts of
interest, it´s still the standard of care for septic shock. But what about
sepsis in the trauma patient?



A systematic review in the journal Shock compared mortality in burn,
trauma, and general medical patients who suffered from sepsis. The authors
found 9 burn studies, 11 trauma, and 18 general critical care. Of note, the
average age of burn and trauma patients with sepsis was considerably lower
than that of general medical patients. Incidence of sepsis and mortality
were also lower in the trauma patients than in the burn and critical care
patients. Difficulties with this kind of comparison include the fact that
SIRS criteria may not apply in trauma patients and the fact that many ICU
patients are admitted with sepsis while burn and trauma patients develop it
as a complication of their underlying injury.



It stand to reason that more studies must be done to create validated
criteria to identify sepsis in each specific patient population, the
organisms that are most common in each population, as well as to separate
the roles that age and gender might play in outcomes.



Reference:

Mann EA, Baun MM, Meininger JC, Wade CE. Comparison of Mortality Associated
with Sepsis in the Burn, Trauma, and General Internsive Care Unit Patient:
A Systematic Review of the Literature. *Shock*, Vol 37, No 1, pp4-16, 2012

this post is from Dr. Melissa Marinelli