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Orthobullets Trauma > Necrotizing Fasciitis > Flashcards

Necrotizing Fasciitis Flashcards

1
Q

immune suppression risk factors for necrotizing fasciitis

A

diabetes
AIDS
cancer
obesity

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2
Q

bacterial introduction risk factors for necrotizing fasciitis

A

IV drug use
hypodermic therapeutic injections
insect bites
skin abrasions
abdominal and perineal surgery

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3
Q

associated conditions

A

cellulitis may or may not be present

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4
Q

what is necrotizing fasciitis?

A

life-threatening bacterial soft tissue infection that spreads along soft tissue planes rapidly.

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5
Q

life-threatening bacterial soft tissue infection that spreads along soft tissue planes rapidly.

A

necrotizing fasciitis

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6
Q
A
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7
Q

Polymicrobial
Typically 4-5 aerobic and anaerobics pecies cultured:
Non-Group A Strep
Anaerobes including Clostridia
Facultative anaerobes
Enterobacteria
Synergistic virulence between organisms

A

type 1

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8
Q

what is type 1 necrotizing fasciitis

A

Polymicrobial
Typically 4-5 aerobic and anaerobics pecies cultured:
Non-Group A Strep
Anaerobes including Clostridia
Facultative anaerobes
Enterobacteria
Synergistic virulence between organisms

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9
Q

Monomicrobial
Group A β-hemolytic Streptococci is most common organism isolated

A

type 2

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10
Q

what is type 2 necrotizing fasciitis?

A

Monomicrobial
Group A β-hemolytic Streptococci is most common organism isolated

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11
Q

Marine Vibrio vulnificus
(gram negative rods)

A

type 3

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12
Q

what is type 3 necrotizing fasciitis?

A

Marine Vibrio vulnificus
(gram negative rods)

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13
Q

fungal

A

type 4

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14
Q

what is type 4 necrotizing fasciitis?

A

fungal

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15
Q

Most common (80-90%)
Seen in immunosuppressed (diabetics and cancer patients)
Postop abdominal and perineal infections

A

type 1

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16
Q

type 1 characteristics

A

Most common (80-90%)
Seen in immunosuppressed (diabetics and cancer patients)
Postop abdominal and perineal infections

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17
Q

5% of cases
Seen in healthy patients
Extremities

A

type 2

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18
Q

Marine exposure

A

type 3

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19
Q

type 2 characteristics

A

5% of cases
Seen in healthy patients
Extremities

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20
Q

localized abscess or cellulitis with rapid progression
minimal swelling
no trauma or discoloration

A

early symptoms

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20
Q

early symptoms

A

localized abscess or cellulitis with rapid progression
minimal swelling
no trauma or discoloration

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21
Q

severe pain
high fever, chills and rigors
tachycardia

A

late findings

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22
Q

late findings:

A

severe pain
high fever, chills and rigors
tachycardia

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23
Q

physical exam shows:

A

skin bullae
discoloration
ischemic patches
cutaneous gangrene
swelling, edema
dermal induration and erythema
subcutaneous emphysema (gas producing organisms)

24
Q

radiographs?

A

not required

25
Q

biopsy indications

A

emergent frozen section can confirm diagnosis in early cases

26
Q

biopsy technique

A

take 1x1x1cm tissue sample
can be performed at bedside or in operating room
surgical intervention should not be delayed to obtain

27
Q

necrosis of fascial layer
microorganisms within fascial layer
PMN infiltration
fibrinous thrombi in arteries and veins and necrosis of arterial and venous walls

A

necrotizing fasciitis

28
Q

histological findings:

A

necrosis of fascial layer
microorganisms within fascial layer
PMN infiltration
fibrinous thrombi in arteries and veins and necrosis of arterial and venous walls

29
Q

LRINEC scoring system score > 6 has PPV of _____% of having necrotizing fasciitis

A

92

30
Q

what are the components of the LRINEC scoring system?

A

CRP
WBC
Hemoglobin
Sodium
Creatinine
Glucose

31
Q

CRP cutoff

A

> 150

32
Q

CRP >150 = how many points?

A

4

33
Q

WBC <15 = how many points?

A

0

34
Q

WBC 15-25=how many points?

A

1

35
Q

WBC >25 = how many points?

A

2

36
Q

hemoglobin >13.5 = how many points?

A

0

37
Q

hemoglobin 11-13.5 = how many points?

A

1

38
Q

hemoglobin <11 = how many points?

A

2

39
Q

sodium <135 = how many points?

A

2

40
Q

creatinine >141 = how many points

A

2

41
Q

sodium cutoff

A

<135

42
Q

creatinine cutoff

A

> 141

43
Q

glucose >10 = how many points

A

1

44
Q

differential

A

gas gangrene

45
Q

treatment options

A

emergency radical debridement with broad-spectrum IV antibiotics
amputation

46
Q

indications for emergency radical debridement with broad spectrum IV antibiotics

A

whenever suspicion for necrotizing fasciitis

47
Q

liquefied subcutaneous fat
dishwater pus
muscle necrosis
venous thrombosis

A

necrotizing fasciitis

48
Q

operative findings

A

liquefied subcutaneous fat
dishwater pus
muscle necrosis
venous thrombosis

49
Q

____ monitoring with systemic resuscitation is critical

A

hemodynamic

50
Q

hyperbaric oxygen chamber if _____ organism identified

A

anaerobic

51
Q

initial antibiotics start empirically with:

A

penicillin
clindamycin
metronidazole
and an aminoglycoside

52
Q

antibiotics for for strep or clostridium

A

penicillin G

53
Q

antibiotics for for polymicrobial

A

imipinem or meropenem or doripenem

54
Q

if MRSA suspected add these antibiotics

A

vancomycin or daptomycin

55
Q

low threshold for ___ when life threatening

A

amputation

56
Q

mortality rate:

A

32%

57
Q

mortality correlates with time to _____

A

surgical intervention

Orthobullets Trauma (63 decks)

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