Tiffany Ezepue, MD
Resident Doctor
Burke Rehabilitation Hospital
Keyport, New Jersey, United States
Joseph Seldin, DO
Attending
Jacobi/NYCHC
Bronx, New York, United States
A 38-year-old male presented to the hospital for septic shock secondary to meningococcemia. His hospital course was significantly complicated, however most notable for vasopressor induced necrosis of digits of all extremities. He now has had infrapatellar amputation of left foot and is being followed by vascular surgery for auto-amputation versus definitive amputation of digits of bilateral hands as well as non-healing ulcer of left foot with vac (negative pressure wound therapy) placement.
Sepsis is an inflammatory response to infection which can evolve into septic shock: hypotension despite adequate resuscitation complicated by end-organ failure. It’s the leading cause of admission and death in the intensive care unit. Vasopressors are first-line in treating septic shock, however, it doesn’t come without risk: end-organ hypoperfusion. Our patient sustained vasopressor-induced acute limb ischemia (VIALI), a known complication of the management of shock, however, there is not much by way of literature and studies to prevent and manage this devastating outcome. In the limited resources, some measures taken to mitigate the complications include: external warming of extremities, nitroglycerin paste application to extremity, arterial assist pump, anticoagulation, or frequent rounding with consistent documentation. Our patient had early vascular surgery intervention, frequent extremity checks and media uploads to his chart, and physical and occupational therapy when appropriate to start. Lastly, neuropsychology/psychiatry services were consulted for this new major life adjustment.
Sepsis and septic shock are serious emergencies that require efficient management, but are associated with known, rare complications that can be mitigated. Providers must be vigilant in the acute care setting to prevent, or at the very least, intervene early to their patient a chance to achieve best outcomes in the rehabilitation phase of recovery.
