Resident Report
description
Transcript of Resident Report
7/26/2011
Left Lower Leg
• First described by Hippocrates in 5th centry as a complication from erysipelas
• "...the erysipelas would quickly spread widely in all directions. Flesh, sinews and bones fell away in large quantities...Fever was sometimes present and sometimes absent...There were many deaths. The course of the disease was the same to whatever part of the body it spread."
NECROTIZING FASCIITIS
• Incidence (low end) – 500-1000 per year nationally
• Predisposing factors – immunosuppression, DM, malignancy, drug abuse (IVDU), CKD
• 50% of patients have hx of skin injury• 25% have blunt trauma• 70% have one ore more chronic illnesses
NECROTIZING FASCIITIS
• Systemic signs – fever, tachycardia, hypotension• NF more commonly seen in extremities; can be
seen on any part of body• Other findings include erythema, induration,
tenderness, fluctuance, skin necrosis and bullae
PHYSICAL DIAGNOSIS
• Leukocytosis• Elevated BUN and Cr• Elevated CK• Elevated CRP• Hyponatremia commonly seen
LAB FINDINGS
• Type I – Polymicrobial infection with aerobic and anaerobic bacteria; tends to affect the chronically ill – DM, immuncompromised, etc.
• Type II – Tends to be Group A Strep and can affects people indiscriminately
NECROTIZING FASCIITIS
• Implicated organisms• Group A Strep• S. aureus• A. hydrophila• E. coli• Klebsiella• Clostridium perfringens• Vibrio vulnificus
NECROTIZING FASCIITIS
• Immediate surgical consult
• If you suspect Type I • Ampicillin/Sulbactam + Clinda/Metronidazole• Can substitute Piperacillin/Tazobactam for Amp/Sul
• If you suspect Type II• Clindamycin and/or Penicillin • Vancomycin in areas where community-acquired MRSA is
prevalent
TREATMENTS
• Understand the signs and symptoms that make one suspect necrotizing fasciitis
• Get appropriate specialists involved quickly – Surgery, ID
• Recognize higher risk of chronically ill patients to get this disease
• Know causative organisms and treatments
TAKE HOME POINTS