Septic Emboli

Hadoff at 06:00, Septic activation; SIRS X 3, lactate 4.. Fluid resuscitated at hour three, completed 3L LR bolus. Hemodynamics; SV 89, CO 7L/min, SVR 856 after second vasopressor support. Patient is intubated and sedated.

Background: Patient was a trauma activation 7 days prior with multiple surgical intervention including spleenectomy persisted to be hypotensive despite fluid resuscitation and multiple blood transfusion. On day 5, patient was found to have an embolic stroke on head CT, confirmed on MRI.

What is going on with this patient?

The patient was diagnosed with nontraumatic cerebral septic emboli, a condition that is less
common in trauma patients and more common in cases of endocarditis, septic thrombophlebitis, and central venous catheter infections. The condition has a 50% mortality rate if not detected promptly and appropriate treatment administered.

Case reports and research on CSE in infective endocarditis (IE) show the origin to be dislodgment of cardiac vegetation followed by vessel occlusion, which results in infarct or ischemia. When the patient continues to show hypotension and possible sepsis without a source, IE should be considered. Cerebral artery occlusion from infarct or transient ischemic attacks accounts for 40% to 50% of central nervous system complications in IE.

Source and reference: Septic Emboli Resulting From Severe Trauma: A Primer on Care

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