Gangrene Flashcards
What is gangrene
Complication of necrosis characterised by decay of body tissues from ischaemia, infection or trauma
Ischaemic gangrene or infectious
Risk factors fro gangrene
Diabetes
Smoking
Atherosclerosis
Raynauds
PAD
Renal disease
Drugs and alcoho
Maliganacy
Truama
Abdo surgery
Contaminated wounds
Malnutrition
Trauma or abdo surgery
Contaminated wounds
malnutirtion
Hypercoaguability
Prolonged tourniquet use
Community aquired MRSA
Treatment gangrene
Early recongition vital
Surgical debridement
Appropriate IV antibiotis
Intense supportive care
Ischaemic -> revascularisation for obstruction and VTE and optimising underlying disease
Bloods in gangrene
FBC
Metabolic panel
Serum LDH
Coagulation panel
Eron classification levels cellulitis
Class 1 - no systemic toxicity or comorbidituy
Class 2 - systemic toxicity or comborbiditiy
Class 3 - significant above
Class 4 - sepsis or life threatening
What eron classification use IV antibiotics in
Class 3 or 4
Admission for frail, v young or immunocomp patients
Facial, periorbital or orbital celluitis
Use flucloazacillin
What antibiotic is used for cellulitis newar eyes or nose
Co-amoxicalv
Most common causes of soft tissue infection
Staphylococcus aureus
Group A streptococcus (mainly streptococcus pyogenes)
Group C streptococcus (mainly streptococcus dysgalactiae)
Consider MRSA
What is buerger disease
thromboangiitis obliterans. It is an inflammatory condition that causes thrombus formation in the small and medium-sized blood vessels in the distal arterial system (affecting the hands and feet).
Strong ass with smoking, men 25-35
Manage by stoppung smoking incl IV iloprost - prostacyclin
Painful blue fingers
Gangrene can be coplication
What is dry vs wet gangrene
where the blood flow to an area of the body becomes blocked = dry
Injury and bacteria = wet
What is gas gangrene
where an infection develops deep inside the body and the bacteria responsible begin releasing gas
What is internal gangrene
where the blood flow to an internal organ, usually the intestines, gallbladder or appendix, becomes blocked
Gangrene symptoms
red, purple or black skin in the affected area, which may be harder to see on black or brown skin
swelling of the affected area
either a loss of sensation or severe pain in the affected area
sores or blisters that bleed or release a dirty-looking or foul-smelling discharge (if the gangrene is caused by an infection)
Septic shock
a rapid but weak pulse
dizziness when you stand up
a change in your mental state, such as confusion or disorientation
breathing difficulties
vomiting
diarrhoea
cold, clammy and paler than usual skin
Investigations
Bloods
Fluid or tissue cuture
Blood cultures
Imaging - X ray, MRI, CT depending on loation
Surgery and biopsy
