The Intern At Work: Internal Medicine 84. A shock to the system- Toxic Shock Syndrome
Apr 4, 2021
A deep dive into toxic shock syndrome, exploring how superantigens provoke a cytokine storm. Discussion of common sources, diagnostic criteria, and key exam findings. Practical guidance on initial resuscitation, empiric antibiotics, source control, and when to call ICU. Reviews lab and imaging strategies, clindamycin and IVIG roles, and contact prophylaxis considerations.
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Different Sources And Culture Yields Matter
- Major sources include skin/soft tissue infections, surgical or postpartum wounds, and retained foreign bodies like tampons or nasal packing.
- Blood cultures are positive ~60% in streptococcal TSS but only ~5% in staphylococcal TSS, affecting diagnostic strategy.
Stabilize Early And Involve ICU Quickly
- Prioritize ABCs, IV access, monitoring, and early fluid resuscitation because 50% of patients initially normotensive become hypotensive within 4 hours.
- Get ICU involved early due to high mortality: streptococcal TSS 30–72%, staphylococcal TSS 5–15%.
History Focused On Source And Necrotizing Fasciitis
- On history target source, ask about recent skin trauma, surgeries, tampon use, last menstrual period, and localizing infectious symptoms.
- Consider necrotizing fasciitis if pain out of proportion, bullae, crepitus, or skin necrosis accompany suspected TSS.