Symmetric Peripheral Gangrene: an underrecognized entity in the septic shock patient

A review of the evidence

1 CPD Points, 1 CEUs, 1 AMA PRA Category 1 Credits.
Providers: CPDUK, CBRN, EB Medicine

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Professor Phil Dellinger help_outline
Professor of Medicine and Distinguished Scholar at Cooper Medical School of Rowan University, USA
Lecture Summary

Acute focal and generalized peripheral ischemia are seen in a wide array of acute illnesses. The term symmetric peripheral gangrene (SPG) is most often used to describe generalized peripheral ischemia that is associated with disseminated intravascular coagulation (DIC) induced microvascular thrombosis leading to gangrene with symmetric acral(peripheral body parts) distribution. SPG is usually caused by infection-induced DIC and when present often co-exists with sepsis-induced multi-organ dysfunction/failure as well as septic shock. Since many of these patients are receiving vasopressors SPG is often misdiagnosed as vasopressor induced peripheral ischemia. Since cases are rare, there is no evidence-based medicine that supports any particular treatment. We will discuss the pathophysiology and differential diagnosis of SPG as well as potential treatments based on chalkboard logic and case report anecdotal experience.

Target Audience

Critical Care Doctors
Experienced or advanced Critical Care Nurses

Learning Objectives:

Upon completion of this activity, you should be able to:

  • Define SPG as well as appreciate how the definition has evolved over the last 130 years
  • Differentiate SPG from diffuse peripheral ischemia from other causes
  • Understand the pathophysiology driving SPG
  • Contrast association versus cause and effect as to vasopressor use and SPG
  • Postulate potential treatments for SPG
Release Date

1 November 2020

Termination Date

31 October 2023

Accreditation

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of EB Medicine and Continulus. EB Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation

EB Medicine designates this internet-enduring material for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Needs Assessment

The need for this educational activity was determined by surveys of the target audience and experts in the specialty. Further assessment was provided by examining the topics of recently published evidence-based medicine reviews, national clinical guidelines, and specialty society recommendations, as well as suggestions from evaluations of previous learning programs to determine practice gaps.

CME Faculty Disclosure

It is the policy of EB Medicine to ensure objectivity, balance, independence, transparency, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. In compliance with all ACCME Essentials, Standards, and Guidelines, all faculty for this CME activity were asked to complete a full disclosure statement. The speaker did not report any relevant financial interest or other relationship with the manufacturer(s) of any commercial product(s) discussed in this educational presentation.

Earning Credit

In order to earn CME credit, the participant must take the pre-test, watch the course, take the CME post-test, and complete the post-test evaluation.

Hardware/Software Requirements

Online learners will need a computer or web-enabled device to access the podcast, additional learning materials, and CME test.