CURRENT Essentials of Critical Care.pdf

274 Current Essentials of Critical Care■■■Toxic Shock SyndromeEssentials of Diagnosis• Multisystem illness characterized by rapid onset of fever, vomiting,watery diarrhea, pharyngitis, profound myalgias with accompanyinghypotension• Diffuse blanching truncal erythema early, accentuated in axillaryand inguinal folds, spreading to extremities; desquamationof skin, palms and soles occurs in second or third week• Multi-organ system involvement, with acute renal failure, acuterespiratory distress syndrome (ARDS), refractory shock, ventriculararrhythmias, and DIC may occur• Highest incidence in menstruating women, persons with localizedor post-surgical staphylococcal infection, and women usingdiaphragm or contraceptive spongeDifferential Diagnosis• Scarlet fever/Streptococcal toxic shock-like disease• Kawasaki disease• Rocky Mountain spotted fever• Drug eruptions/Stevens-Johnson syndrome• Measles• Leptospirosis• Sepsis syndrome with multi-organ system failureTreatment• Immediate removal of tampon, contraceptive device, or surgicalpacking• Surgical drainage, irrigation of focal abscess• Supportive care, with fluid resuscitation and management of organsystem failure• Anti-staphylococcal antibiotic, though effect on outcome unclear■ PearlIntense hyperemia of conjunctival, oropharyngeal, and vaginal surfacesare frequent findings in toxic shock syndrome.ReferenceProvost TT, Flynn JA (editors): Cutaneous medicine: Cutaneous manifestationsof systemic disease. BC Decker, 2001.