Necrotizing Fasciitis (NSTI)

Question 1

What Dx/ Tx

(1) Most frequently occurs in the extremities (Predilection for the lower leg) and may mimic DVT.
(2) Initially there is pain, erythema, edema, cellulitis and high fever.
(3) The pain is progressive, relentless, and severe and is often out of proportion to the severity of the physical findings.
(4) Skin exam may be unrevealing early on, or may be confused with cellulitis or abscess; may see blistering, crepitus, soft tissue edema, erythema, discoloration, necrosis, bullae, vesicles, or ulceration.

Answer 1

Necrotizing Fasciitis
Treatment
(1) Prompt and wide surgical debridement is the CORNERSTONE of treatment.
(2) Broad-spectrum antibiotics should be administered once diagnosis of NSTI is suspected.
Disposition
(1) Immediate medevac is required for this patient.
(2) Close contacts of patients and health care workers do not require chemoprophylaxis with antibiotics (good to brief the CoC on)

Question 2

________ are rare and rapidly progressing infections involving any layer of soft tissue including skin, subcutaneous fat, fascia, and/or muscle

Answer 2

Necrotizing soft tissue infections (NSTI)

Question 3

True/False

NSTI does not represent a medical emergency.

Answer 3

FALSE

Question 4

What is essential in improving outcomes for NSTI Patients?

Answer 4

Early diagnosis, prompt surgical consultation, and initiation of broad-spectrum antibiotics

Question 5

True/ False
Necrotizing infection can occur among healthy individuals with no past medical history or clear portal of entry in any age group.

Answer 5

True

Question 6

NSTI DDx

Answer 6

(1) Deep Vein Thrombosis

(2) Cellulitis

Question 7

Labs/Studies/Imaging NSTI

(1) MRI: May show _____ along the fascial plane.
(2) X-ray, CT or US are useful in demonstrating the ______ in the soft tissues.
(3) Cultures: Group A Strep and mixed aerobic and anaerobic bacteria.
(4) Direct inspection at surgery shows the fascia is swollen and dull gray with areas of ______ tissue.

Answer 7

1) edema
2) air bubble
3) necrotic

Question 8

__________ should be the goal with the first surgery. This may require amputation of an extremity to control the disease. Surgical debridement is repeated until all infected devitalized tissue is removed.

Answer 8

Extensive, definitive debridement

Question 9

NSTI Complications

Answer 9

(1) Toxic shock syndrome (acute toxin-mediated febrile illness caused by the productionand release of exotoxins by S. aureus.
(2) Amputation
(3) Septic shock
(4) Death