Necrotizing Fasciitis Flashcards
what is necrotizing fasciitis?
progressive, rapidly spreading inflammatory infection of the skin, subQ tissue, deep fascia, and muscle
does necrotizing fasciitis have a high mortality rate?
yes (80%)
what is type 1 necrotizing fasciitis
mixed infection involving aerobic and anaerobic bacteria
usually occurs after trauma or surgery
what is type 2 necrotizing fasciitis
single infection due to group A beta-hemolytic streptococci
mostly commonly called a flesh eating bacteria
usually enters the body by a minor cut or scrape
necrotizing fasciitis pathophysiology
-infecting bacteria enters host through local tissue injury or mucous membrane barrier
-organisms proliferate in an environment of tissue hypoxia
-superficial nerves are destroyed resulting in necrosis of surrounding tissue
-fascia and fat are destroyed
-bacteria spreads through tissue & enters bloodstream
-leads to shock, causing vital organs to shut down, potentially leading to coma or death
what is the most problematic thing about necrotizing fasciitis?
presents like other infections so its hard to treat and diagnose early
necrotizing fasciitis risk factors
-trauma
-skin breach
-mucosal breach
-recent surgery
-advanced age
-obesity
-malnutrition
-DM
-immunosuppression
-PVD
-alcoholism
-malignancy
-CKD
-liver disease
-IV drug use (b/c it breaks the skin)
-smoking
average age necrotizing fasciitis occurs
38-44
what sex does necrotizing fasciitis affect more?
male
necrotizing fasciitis complications
-kidney failure
-septic shock
-scarring and cosmetic deformities
-myositis
-myonecrosis
-amputation
-vision loss
-often have anuria
necrotizing fasciitis assessment - history
-associated risk factors
-pain
-tissue injury
-malaise
-anorexia (N/V/D)
-initial flulike symptoms, such as chills and malaise
necrotizing fasciitis assessment - physical findings
-rapid progressive erythema at the site of insult, progressing to a dusky purple color
-bullae with clear, hemorrhagic, or foul smelling drainage
-large areas or gangrenous skin (5-7 days)
-crepitus in the area
-“woody” feel on palpation
-extensive necrosis of the SQ tissue
-fever
-sepsis
-hypovolemia
-hypotension
-diaphoresis
-respiratory insufficeincy
-deterioration level of consciousness
necrotizing fasciitis lab tests/results
-CBC may reveal leukocytosis or anemia
-BUN & creatinine might be elevated
-decreased sodium level
-elevated LFTs
-c-reative protein, glucose, creatinine kinase might be elevated
-tissue biopsy shows level of infiltration
what will imaging of necrotizing fasciitis show you?
shows SQ gas and necrosis
finger test
slit area of wound & put finger in it
if it’s not bleeding, there’s no resistance, & grey fluid that means NF
