necrotizing fasciitis

Question 1

necrotizing fasciitis overview

Answer 1

extensive necrosis of SQ tissue and facia
mortality rate
15-34 %
> 70 % with toxic shock
death with out surgery

most common organisms:
group A streptococci
- increasing in incidence
mix facultative anaerobic flora
- mixed flora develop the gas pattern

risk factors
diabetes
IVDA
chronic liver and renal disease
maligancy

Question 2

clinical manifestations of necrotizing fasciits

Answer 2

toxic appearence , bullae , skin necrosis, and rhabdomyolysis

physical findings:
minimal compared to severity of pain and fever
soft tissue edema and erythema

infected areas
red , hot , shiny , swollen and tender

untreated
develop blue-grey patches after 36 hours
cutaneous bullae and necrosis 3-5 days

pain decreases
thrombosis or small vessels
destruction of peripheral nerves

necrotizing fascitis due to clostridium perfingens
- extremely toxic
- high mortality
- 48 hours rapid tissue invasion an systemic toxicity

Question 3

Necrotizing Fasciitis diagnosis and treatment

Answer 3

lab:
sepsis work up
Management:
IV fluid
antibiotics
vancomycin plus clindamycin plus gentamicin

adjust based on culture data
distinction organism
muscle biopsy

urgent surgical debridement
essential