All right, so welcome back to the Internet Booker for Critical Care podcast.

I'm here with Adam Thomas, and we're going to talk about purper of full bonnance.

Josh, I'm really excited about this because A, I've screwed this up a lot.

B, I didn't really recognize this as a thing until you told me a couple years ago and C,

this sets the groundwork

for exploring DIC in general in the clotty-clotty and bleedy, bleedy subty.

So what is perpherophominins and why have I screwed this up?

So perper fulminans is essentially a form of disseminated intravascular coagulation

marked by profound macrobascular thrombosis. So, you know, there's different flavors of disseminated intrabascular coagulation marked by profound macrobascular thrombosis.

So, you know, there's different flavors of disseminated intravascular coagulation.

Some of them are bleeding. Some of them are clotty. This is kind of the most, one of the more

thrombotic extremes. And it's marked predominantly by microbascular thrombosis, the skin causing

a lot of skin necrosis. You can also have necrosis of the adrenal glands and the kidneys. But I think this is super important to recognize as a separate entity, kind of similar to our post on toxic shock

syndrome. A lot of times I think people kind of like roll together generic septic shock,

toxic shock, and perperulminants, and they're really different things. And I think, you know,

as we'll discuss more later, the per performinants really probably requires specific management. So we're not serving our patients well

when someone comes in with like meningoccemia and per per fulminans. And we're just like,

all right, they have septic shock, just like, you know, give them 30 cc's per kilo and stuff.

The collective sigh, would someone please treat the thromboses? Josh, before we go into subtypes though, because in my mind, I think we've all seen these patients, let's bring it to bear.

So those modeling, that like crazy levator reticularis everywhere that you just think is shock.

And then over days you start to get digital ischemia, bulli, those kind of things. Traditionally, we just say, oh man, that's like really bad septic shock and the pressers did that.

Tell me otherwise.

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