CONTENTS


basics

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general concept
types of necrotizing fasciitis


clinical presentation

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skin examination:  early findings are less specific 
skin examination:  late findings are more specific
systemic manifestations
Fournier's gangrene

laboratory abnormalities

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⚠️ Necrotizing fasciitis is not a laboratory diagnosis.  Deranged labs should increase your index of suspicion, but patients can have early necrotizing fasciitis with mostly normal labs.

laboratory changes which may be seen include:
clostridial infections may cause a unique pattern of laboratory abnormalities:
LRINEC score for necrotizing fasciitis

ultrasonography

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5 Minute Sono by Dr. Jacob Avila

finding of gas within the skin 
abnormal fascia


imaging

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CT vs. MRI
contrast enhanced CT scan
plain radiography

bedside surgical exploration

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surgical exploration
how this works

sepsis resuscitation

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antibiotics

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preferred regimen for empiric therapy of necrotizing fasciitis:

surgical debridement

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therapy for toxic shock syndrome

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extra oxygen

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theoretical rationale
hyperbaric oxygen therapy
providing a higher FiO2 level

podcast

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questions & discussion

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To keep this page small and fast, questions & discussion about this post can be found on another page here.

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References

  • 15849047  Norrby-Teglund A, Muller MP, Mcgeer A, Gan BS, Guru V, Bohnen J, Thulin P, Low DE. Successful management of severe group A streptococcal soft tissue infections using an aggressive medical regimen including intravenous polyspecific immunoglobulin together with a conservative surgical approach. Scand J Infect Dis. 2005;37(3):166-72. doi: 10.1080/00365540410020866  [PubMed]
  • 23846850  Yue J, Dong BR, Yang M, Chen X, Wu T, Liu GJ. Linezolid versus vancomycin for skin and soft tissue infections. Cochrane Database Syst Rev. 2013 Jul 12;(7):CD008056. doi: 10.1002/14651858.CD008056.pub2  [PubMed]
  • 27483003  Harbrecht BG, Nash NA. Necrotizing Soft Tissue Infections: A Review. Surg Infect (Larchmt). 2016 Oct;17(5):503-9. doi: 10.1089/sur.2016.049  [PubMed]
  • 29672405  Fernando SM, Tran A, Cheng W, Rochwerg B, Kyeremanteng K, Seely AJE, Inaba K, Perry JJ. Necrotizing Soft Tissue Infection: Diagnostic Accuracy of Physical Examination, Imaging, and LRINEC Score: A Systematic Review and Meta-Analysis. Ann Surg. 2019 Jan;269(1):58-65. doi: 10.1097/SLA.0000000000002774  [PubMed]
  • 31284035  Peetermans M, de Prost N, Eckmann C, Norrby-Teglund A, Skrede S, De Waele JJ. Necrotizing skin and soft-tissue infections in the intensive care unit. Clin Microbiol Infect. 2020 Jan;26(1):8-17. doi: 10.1016/j.cmi.2019.06.031  [PubMed]
  • 31584343  Tessier JM, Sanders J, Sartelli M, et al. Necrotizing Soft Tissue Infections: A Focused Review of Pathophysiology, Diagnosis, Operative Management, Antimicrobial Therapy, and Pediatrics. Surg Infect (Larchmt). 2020 Mar;21(2):81-93. doi: 10.1089/sur.2019.219  [PubMed]
  • 32323044  Fozard J, Shafer K, Kehrl T. Sonographic exploration for fascial exploration (SEFE) in necrotizing fasciitis: a case report. Ultrasound J. 2020 Apr 22;12(1):24. doi: 10.1186/s13089-020-00168-5  [PubMed]
  • 32394067  Urbina T, Madsen MB, de Prost N. Understanding necrotizing soft tissue infections in the intensive care unit. Intensive Care Med. 2020 Sep;46(9):1739-1742. doi: 10.1007/s00134-020-06071-w  [PubMed]
  • 33278180  Eckmann C, Montravers P. Current management of necrotizing soft-tissue infections. Curr Opin Infect Dis. 2021 Apr 1;34(2):89-95. doi: 10.1097/QCO.0000000000000700  [PubMed]
  • 33303335  Stevens DL, Bryant AE, Goldstein EJ. Necrotizing Soft Tissue Infections. Infect Dis Clin North Am. 2021 Mar;35(1):135-155. doi: 10.1016/j.idc.2020.10.004  [PubMed]