1. Interesting case presentation
Nadia Rahati
EM resident PGY1
Iran University of Medical sciences
July 2014
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2. Present Illness
A 30 years old man arrived to emergency department with chief compliment from abdominal pain that had accrued after Blunt trauma from 2 days ago his pain was localized in left lower abdominal Area
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3. Past Medical History
NO ILLNESS AND NO DRUG USE
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4. Physical Examination GA: .an ill young man VS:
.Bp:120/80 PR:100 /min RR:18 T:38:
Chest phE:
No remarkable finding
Abdominal phE:
Scar(linear laceration) ecchymosis(-)Bs(NL) mass(-) guarding (-) tenderness(+)
Neurological phE:
NORMAL
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5. PROBLEM LIST An young man Decrease abdominal pain after blunt trauma
Temperature :38
Ill and toxic
Small, red, painful lump on the skin
Chills
Nausea
Dizziness
Weakness
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6. Laboratory tests CBC: Biochemistry:
WBC: Na:130 k: Bs:100 Bun:21
Hg: Cr:1/2 Ca:9
PLT:17
MCV:87.88
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7. ED ORDERS IV line fixed CBC,BUN,CR,Na,k,Bs,amylase,ALT,AST
IV fluid N/S 500cc infusion /4 hours
Acetaminophen 1 gr iv infusion /20 min
ECG
CXR
Bed side abdominal ultrasonography
Spiral abdominal pelvic ct scan
Transfer to acute 1
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8. CHEST X RAY
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9. Pelvic x ray
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10. Cervical x ray
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11. FASCIITIS NECROTIZING
Necrotizing fasciitis is an infection of striker fascia, usually caused by multiple pathogens develops. Thrombosis, cardiovascular disease, infectious character of the interface skin and blood circulation deep ones. As a result, skin necrosis, ischemia or gangrene develops
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12. RADIOGRAPHIC FEATURES
Plain film
The common plain radiographic findings non specific an often similar to those of cellulitis, with increased soft-tissue thickness and opacity. Radiographs can be normal until the advanced stages of infection and necrosis. The characteristic finding of gas in the soft tissues is seen in only a minority of cases. CT
CT classically tends to show soft-tissue gas associated with fluid collections within the deep fascia, although this finding is inconstant.
Other non specific findings include
asymmetrical fascial thickening associated with fat stranding
edema extending into the inter-muscular septa and the muscle
thickening of one or both of the superficial and deep fascial layers
Although fascial fluid collections are typically non-focal, abscesses may be seen.
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13. Soft tissue necrotizing ct
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14. SOFT TISSUE NECOTIZING
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15. Late diagnosLATE DIAGNOSED NECROTIZING fasciitis as a cause of multiorgan dysfunction syndrome
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16. TREATMENT
The treatment for NSTI involves the principles of treatment for any kind of surgical infection: source control, antimicrobial therapy, support, and monitoring. It is clear that early and complete debridement is essential for the treatment of NSTI.
Broad-spectrum antimicrobial therapy should be started early to include coverage for gram-positive, gram-negative, and anaerobic organisms. Special consideration for group A Streptococcus and Clostridium species should be taken.
. Acceptable regimens include monotherapy agents, such as imipenem, meropenem, ertapenem, piperacillin/tazobactam, and tigecycline. Multidrug regimens have also been described, including triple-drug therapy regimens, such as high-dose penicillin, high-dose clindamycin, and a fluoroquinolone or an aminoglycoside for coverage of gram-negative organisms
Amputation if the disease spreads through an arm or leg
100% oxygen at high pressure (hyperbaric oxygen therapy) for certain types of bacterial infections
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