Necrotizing Fasciitis

Question 1

immune suppression risk factors for necrotizing fasciitis

Answer 1

diabetes
AIDS
cancer
obesity

Question 2

bacterial introduction risk factors for necrotizing fasciitis

Answer 2

IV drug use
hypodermic therapeutic injections
insect bites
skin abrasions
abdominal and perineal surgery

Question 3

associated conditions

Answer 3

cellulitis may or may not be present

Question 4

what is necrotizing fasciitis?

Answer 4

life-threatening bacterial soft tissue infection that spreads along soft tissue planes rapidly.

Question 5

life-threatening bacterial soft tissue infection that spreads along soft tissue planes rapidly.

Answer 5

necrotizing fasciitis

Question 7

Polymicrobial
Typically 4-5 aerobic and anaerobics pecies cultured:
Non-Group A Strep
Anaerobes including Clostridia
Facultative anaerobes
Enterobacteria
Synergistic virulence between organisms

Answer 7

type 1

Question 8

what is type 1 necrotizing fasciitis

Answer 8

Polymicrobial
Typically 4-5 aerobic and anaerobics pecies cultured:
Non-Group A Strep
Anaerobes including Clostridia
Facultative anaerobes
Enterobacteria
Synergistic virulence between organisms

Question 9

Monomicrobial
Group A β-hemolytic Streptococci is most common organism isolated

Answer 9

type 2

Question 10

what is type 2 necrotizing fasciitis?

Answer 10

Monomicrobial
Group A β-hemolytic Streptococci is most common organism isolated

Question 11

Marine Vibrio vulnificus
(gram negative rods)

Answer 11

type 3

Question 12

what is type 3 necrotizing fasciitis?

Answer 12

Marine Vibrio vulnificus
(gram negative rods)

Question 13

fungal

Answer 13

type 4

Question 14

what is type 4 necrotizing fasciitis?

Answer 14

fungal

Question 15

Most common (80-90%)
Seen in immunosuppressed (diabetics and cancer patients)
Postop abdominal and perineal infections

Answer 15

type 1

Question 16

type 1 characteristics

Answer 16

Most common (80-90%)
Seen in immunosuppressed (diabetics and cancer patients)
Postop abdominal and perineal infections

Question 17

5% of cases
Seen in healthy patients
Extremities

Answer 17

type 2

Question 18

Marine exposure

Answer 18

type 3

Question 19

type 2 characteristics

Answer 19

5% of cases
Seen in healthy patients
Extremities

Question 20

localized abscess or cellulitis with rapid progression
minimal swelling
no trauma or discoloration

Answer 20

early symptoms

Question 20

early symptoms

Answer 20

localized abscess or cellulitis with rapid progression
minimal swelling
no trauma or discoloration

Question 21

severe pain
high fever, chills and rigors
tachycardia

Answer 21

late findings

Question 22

late findings:

Answer 22

severe pain
high fever, chills and rigors
tachycardia

Question 23

physical exam shows:

Answer 23

skin bullae
discoloration
ischemic patches
cutaneous gangrene
swelling, edema
dermal induration and erythema
subcutaneous emphysema (gas producing organisms)

Question 24

radiographs?

Answer 24

not required

Question 25

biopsy indications

Answer 25

emergent frozen section can confirm diagnosis in early cases

Question 26

biopsy technique

Answer 26

take 1x1x1cm tissue sample can be performed at bedside or in operating room surgical intervention should not be delayed to obtain

Question 27

necrosis of fascial layer microorganisms within fascial layer PMN infiltration fibrinous thrombi in arteries and veins and necrosis of arterial and venous walls

Answer 27

necrotizing fasciitis

Question 28

histological findings:

Answer 28

necrosis of fascial layer microorganisms within fascial layer PMN infiltration fibrinous thrombi in arteries and veins and necrosis of arterial and venous walls

Question 29

LRINEC scoring system score > 6 has PPV of _____% of having necrotizing fasciitis

Answer 29

92

Question 30

what are the components of the LRINEC scoring system?

Answer 30

CRP WBC Hemoglobin Sodium Creatinine Glucose

Question 31

CRP cutoff

Answer 31

>150

Question 32

CRP >150 = how many points?

Answer 32

4

Question 33

WBC <15 = how many points?

Answer 33

0

Question 34

WBC 15-25=how many points?

Answer 34

1

Question 35

WBC >25 = how many points?

Answer 35

2

Question 36

hemoglobin >13.5 = how many points?

Answer 36

0

Question 37

hemoglobin 11-13.5 = how many points?

Answer 37

1

Question 38

hemoglobin <11 = how many points?

Answer 38

2

Question 39

sodium <135 = how many points?

Answer 39

2

Question 40

creatinine >141 = how many points

Answer 40

2

Question 41

sodium cutoff

Answer 41

<135

Question 42

creatinine cutoff

Answer 42

>141

Question 43

glucose >10 = how many points

Answer 43

1

Question 44

differential

Answer 44

gas gangrene

Question 45

treatment options

Answer 45

emergency radical debridement with broad-spectrum IV antibiotics amputation

Question 46

indications for emergency radical debridement with broad spectrum IV antibiotics

Answer 46

whenever suspicion for necrotizing fasciitis

Question 47

liquefied subcutaneous fat dishwater pus muscle necrosis venous thrombosis

Answer 47

necrotizing fasciitis

Question 48

operative findings

Answer 48

liquefied subcutaneous fat dishwater pus muscle necrosis venous thrombosis

Question 49

____ monitoring with systemic resuscitation is critical

Answer 49

hemodynamic

Question 50

hyperbaric oxygen chamber if _____ organism identified

Answer 50

anaerobic

Question 51

initial antibiotics start empirically with:

Answer 51

penicillin clindamycin metronidazole and an aminoglycoside

Question 52

antibiotics for for strep or clostridium

Answer 52

penicillin G

Question 53

antibiotics for for polymicrobial

Answer 53

imipinem or meropenem or doripenem

Question 54

if MRSA suspected add these antibiotics

Answer 54

vancomycin or daptomycin

Question 55

low threshold for ___ when life threatening

Answer 55

amputation

Question 56

mortality rate:

Answer 56

32%

Question 57

mortality correlates with time to _____

Answer 57

surgical intervention