Infection

Question 1

4 mainstays of infection treatment

Answer 1

Adecuate drainage of pus
Appropriate antibiotics
Splintage
Therapy

Question 2

Kanavel signs

Answer 2

Finger flexed
Finger enlarged
Tenderness over sheet
Pain on passive extension

Question 3

Necrotizing fasciati pathofysiology

Answer 3

Spred in and on fascia using enzymes and causing thrombosis, ischemia and necrosis of overlying tissue

Question 4

Types of necrotizing fasciitis

Answer 4

Type 1 Polymicrobial
Type 2 Monomicrobila Strep A
Type 3 Marine, Vibrio unusual
Type 4 Fungal infection

Question 5

Clinical features

Answer 5

Early: Disproportiante pain (due to angiothrombosis>ischemia>hypoxia superficial nerves). Loss of skin turgor with delayed capillary refill. Malayse, diarrhea

Late: Crepitus, blisters, anesthesia

Question 6

Score for necrotizing fasciitis

Answer 6

LRINEC score - Laboratory Risk Indicator for Necrotising Fasciitis

CRP >150, LPK 15-25, Hb low, Sodium <135, Crea >141, Glucose >10

Question 7

Treatment of necrotizing fasciitis?

Answer 7

1. Blood samples (culture, ABG, lactate, hb, X-match)
2. Antibiotics (B-lactam as Meropeneom and Clindamycin, discuss microbilologist)
3. Resuscitate, involve intensivist/anestesiologist
4. Diagnostic exploration and surgical debridement

Question 8

Exploratory incision

Question 9

How big skin excision in necrotizing fasciitis?

Answer 9

Zone 1 (obvious infected area)

Zone 2 (early signs)

Zone 3 (normal skin)

Excision Zon 1+2 + 2-3cm normal tissue