Ch. 37 Right Leg Pain, Swelling, and Erythema for Two Days

Question 1

What are the 5 “hard signs” of Necrotizing Soft Tissue Infection (NSTI)? What % of patients with NSTI have such hard signs?

Answer 1

• Hypotension
• Crepitus
• Skin necrosis
• Bullae
• Gas on X-ray

Question 2

Why is it important to distinguish between cellulitis and NSTI?

Answer 2

Cellulitis and NSTI are surprisingly difficult to distinguish based on exam. Treatment of NSTI requires emergent surgical debridement of all infected tissue, whereas cellulitis requires abx.

Question 3

• What are the typical organisms seen in NSTI?
• What is the term for NSTI involving the scrotum and/or perineum?
• Initial mgmt for NSTI?
• What imaging is helpful?

Answer 3

• What are the typical organisms seen in NSTI?
  
  • Group A Strep

Clostridium perfringens

• What is the term for NSTI involving the scrotum and/or perineum?
  
  • Fournier’s gangrene
• Initial mgmt for NSTI?
  
  • IV fluids, broad-spectrum IV abx, aggressive surgical debridement (GOLD STANDARD)
• What imaging is helpful?​ plain x-ray to demonstrate gas in soft tissue
  
  • ​CT can also show abscess formation