Australian Sepsis Network

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

1 Credit(s)

1 CPD point, 1 AMA PRA Category 1 Credit, 1 CEU
Providers: CPDUK, EB Medicine, CBRN

Prof. Phil Dellinger Read bio

Prof. Phil Dellinger

Professor Phil Dellinger

Professor of Medicine and Distinguished Scholar at Cooper Medical School of Rowan University, USA

Dr. R. Phillip Dellinger is Professor of Medicine and Distinguished Scholar at Cooper Medical School of Rowan University (CMSRU). He is Senior Critical Care Attending and Director Cooper Research Institute, Cooper University Health (CUH). He is Adjunct Professor, Department of Pulmonary Medicine, University of Texas MD Anderson Cancer Centre. 

Dr. Dellinger has authored over 300 journal articles and book chapters as well as edited over 30 books and journal issues in the field of critical care medicine and lung disease, featuring both laboratory and clinical research. His primary academic interests are new innovative sepsis therapies, sepsis management and sepsis performance improvements. He co-edited the second, third, fourth and fifth edition (2019) of the major critical textbook, Critical Care Medicine (Elsevier). He is the associate editor of Critical Care Medicine journal. 

Dr. Dellinger was inducted as a Master Fellow in the College of Critical Care Medicine in 2012 and is a Past President of the Society of Critical Care Medicine (SCCM). He received the SCCM Distinguished Service Award in 2003, he was the 15th recipient of the SCCM Lifetime Achievement Award in 2015. He is past chairman of the International Sepsis Forum (ISF) and currently stands as an emeritus member of that group. He was the lead author of the 2004, 2008 and 2012 Surviving Sepsis Campaign International Guidelines on the Management of Severe Sepsis and Septic Shock and senior author on the 2016 guidelines. 


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. 

Talk 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.

Learning Objectives:
By the end of this lecture the attendee will be able to:

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

This lecture is equal to 1 CPD Point, 1 AMA PRA Category 1 Credit, and 1 CE Contact Hour.


Additional CME Info

Release Date: February 1, 2020, Termination Date: January 31, 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 Credit™ per lecture. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Commercial Support: This activity received no commercial support.

Earning Credit: In order to earn CME credit, the participant must take the pre-test, listen to the lecture, take the CME post-test, and complete the post-test evaluation.

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