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

The 10 Commandments of Critical Care

A case-based presentation of things not to forget when managing critically ill patients

Critical Care Medicine / Patient Care