Thread by @Me4Trauma

Welcome to the first tweetorial in our Critical Care Corner. Stay tuned for this spooky Halloween thread, hosted by none other than the Addams Family.

We have kept it simple here. Links provided for further reading.
No sensitive images in this thread

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Our topic for today is the “festering” problem of necrotizing fasciitis (NF) otherwise known as “flesh eating bacteria syndrome”. It is a life threatening soft tissue infection,with a mortality rate ranging from 8.6-76% in the literature(median 32.2%)

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It commonly affects the perineum and scrotum (Fournier’s gangrene), the abdominal wall & extremities. Trauma pts, & pts with surgical wounds, are particularly susceptible as the site of trauma can act as a portal of entry for bacteria.

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NF can be classified into different types based on the responsible infectious organism. Type I, which is polymicrobial is the most common.

For further reading & to fully view the table below, check out this comprehensive paper
ncbi.nlm.nih.gov/pmc/articles/P…

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In order to diagnose NF in a timely manner, it is important to have a high index of suspicion. This starts by recognizing a susceptible host particularly pts with diabetes mellitus or immunocompromised pts with signs of sepsis out of proportion to physical findings
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Clues on physical exam include general signs of infection/inflammation: tumor, rubor, calor & dolor. The overlying skin can also erupt into blisters/bullae or appear desquamated/degloved.Crepitus signifies the presence of gas gangrene.Also look for SIRS
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Scoring systems exist to help diagnose & predict mortality of NF, the most famous being the LRINEC score.

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Read more👇🏻

ncbi.nlm.nih.gov/pmc/articles/P…

And

ijsurgery.com/index.php/isj/…

In addition to resuscitation and admission (preferably to ICU or HDU), it is important to summon the sexy duo as EARLY as possible in the management of NF: namely broad spectrum antibiotics and aggressive surgical debridement (Not Morticia and Gomez!)

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Following initial management,certain principles should be followed:
-assess wound regularly,change dressing frequently & re-debride as needed
-tailor antibiotics to tissue culture results
-optimize pt nutrition
-plan for ultimate wound closure(VAC etc)
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Remember, if left untreated or if treatment is delayed, mortality is 100%
Time is of the essence here

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Hope you enjoyed this simple thread. Feel free to ask questions, & plz do check out the links for more details.

Happy Halloween! 💀🎃

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