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2463805956935Management00Management15557506017895Meropenem 1g TDS (use penicillin / cepahzolin instead if Strep pyogenes) + clindamycin; can use antitoxins if clostridium; debridement; HBOIn Fournier’s gangrene: ceftriaxone 2g IV + metronidazole 500mg IV + gentamicin 5mg/kg00Meropenem 1g TDS (use penicillin / cepahzolin instead if Strep pyogenes) + clindamycin; can use antitoxins if clostridium; debridement; HBOIn Fournier’s gangrene: ceftriaxone 2g IV + metronidazole 500mg IV + gentamicin 5mg/kg2438404223385Assessment00Assessment15557504222750Symptoms: pain / tachycardia out of proportional to physical findings; blanching, tense dusky brown/red haemorrhagic bullae crepitus (late; in 13-30%)Investigations: presence of gas on XR not required to make diagnosis; CT 80% sensitivity00Symptoms: pain / tachycardia out of proportional to physical findings; blanching, tense dusky brown/red haemorrhagic bullae crepitus (late; in 13-30%)Investigations: presence of gas on XR not required to make diagnosis; CT 80% sensitivity51981104269105002438402160905Patho-physiology00Patho-physiology15557502160905Burns: pseudomonasDiabetes: staph aureus, bacteroides, enterobacterTrauma: clostridium (C septicum / perfringens (most common cause of gangrene) / novyi); reported in 10-40% necrotising fasciitisGangrene: clostridium, bacteroides, enterobacter, peptostreptococcus; Fournier’s gangrene is mixed aerobic and anaerobic (anaerobic Strep, G-ive rods, anaerobes; B fragilis and E coli most common) necrotising subcutaneous infection dermal gangrene and massive scrotal swellingGas in tissues: clostridium, bacteroides, peptostreptococcus, E coli, Strep pyogenes – infects subcutaneous tissues and muscle; usually requires poor vascular supply Type 1: polymicrobial Type 2: grp A strep +/- staph aureus; usually in younger patients due to trauma / surgeryFoul odour, regional adenopathy: bacteroides00Burns: pseudomonasDiabetes: staph aureus, bacteroides, enterobacterTrauma: clostridium (C septicum / perfringens (most common cause of gangrene) / novyi); reported in 10-40% necrotising fasciitisGangrene: clostridium, bacteroides, enterobacter, peptostreptococcus; Fournier’s gangrene is mixed aerobic and anaerobic (anaerobic Strep, G-ive rods, anaerobes; B fragilis and E coli most common) necrotising subcutaneous infection dermal gangrene and massive scrotal swellingGas in tissues: clostridium, bacteroides, peptostreptococcus, E coli, Strep pyogenes – infects subcutaneous tissues and muscle; usually requires poor vascular supply Type 1: polymicrobial Type 2: grp A strep +/- staph aureus; usually in younger patients due to trauma / surgeryFoul odour, regional adenopathy: bacteroides2438401651000Risk Factors00Risk Factors15487651650365For Fournier’s gangrene: obesity, immunocompromised,diabetes (in 20-70%), alcoholism (in 25-50%), chronic steroid use00For Fournier’s gangrene: obesity, immunocompromised,diabetes (in 20-70%), alcoholism (in 25-50%), chronic steroid use243840964565Epidemiology00Epidemiology1551305963295IVDU, poor social circumstances; mortality 25-35% (40% in Fournier’s gangrene)? mortality: <1yr, >60yrs, IVDU, CRF, CCF, trunk / perineum, peripheral vascular disease, +ive blood culture (strong predictor), delay to treatment00IVDU, poor social circumstances; mortality 25-35% (40% in Fournier’s gangrene)? mortality: <1yr, >60yrs, IVDU, CRF, CCF, trunk / perineum, peripheral vascular disease, +ive blood culture (strong predictor), delay to treatment246380330200Necrotising Fasciitis / Gas Gangrene00Necrotising Fasciitis / Gas Gangrene ................
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