Which finding indicates that a person has gangrene, instead of an infarction, in a lower extremity wound? Bacteria in the wound Tissue ischemia Amputation not required Dead tissue replaced with scar tissue
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It is often caused by an infection, and it can be very dangerous if it is not treated promptly. Show more…
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Case 1.5 A woman is brought to the emergency department where you are working triage. She has an extremely swollen right lower leg. You see what appears to be an old surgical wound in the mid-calf, with rough scar tissue surrounded by purplish-red skin. She is in a lot of pain, and her husband speaks for her. He tells you that three weeks ago she had a group of moles removed from that area. It had appeared to heal initially, but three days ago, the incision area started looking bigger rather than smaller. She did not return to the physician, hoping the condition would resolve itself. In the past three days, the area has begun to swell and become very hot. You call the attending physician immediately because you know that this is a serious condition. The patient is sent straight to surgery where the wound is debrided. Gram-positive cocci growing in chains are recovered from the wound. She is transferred to intensive care and put on high-dose intravenous antibiotics for the next 18 hours. But the next evening, her leg is amputated below the knee. She remains in the hospital for two months following surgery and requires long-term antibiotic therapy and multiple skin grafts on her upper leg. What condition did this patient have? What features suggest that it is not Clostridium perfringens gangrene? Why was amputation the best solution for the infection in this case?
Adi S.
A 62-year-old diabetic man presents in the emergency room with a swollen left leg with areas of blanching and blue mottling. A "foul odor" is coming from a dressed wound. The physicians remove the dressing and a foaming, brownish fluid is seeping from a wounded area. The fluid contains what appear to be small bits of the tissue. No pus appears to be present. The wound has a strong "rotten" odor. Five days earlier, while at his work as a farmer, he caught the leg in his manure spreader, sustaining a deep, crushing, grossly dirty injury. His wife cleaned the wound as well as she could with soap and water, dressed it with clean gauze, and wrapped it tightly with an elastic bandage to stop the bleeding. The second day they redressed the wound and applied triple antibiotic ointment. The patient treated his pain with ibuprofen (Advil). He reported the pain was not very bad for the first 72 hours. In the past 24 hours, the leg swelled and the mottling began to appear. A foul odor and severe pain accompanied the swelling. His wife convinced him to come to the emergency room even though they did not have medical insurance. What is your diagnosis in this case? How should this wound be treated? Is it likely that the patient's diabetes contributed to the problem as presented?
Josee P.
How is it possible for anaerobes to be involved in bite wound infections? Most bite wounds are on hands or fingers, which have little tissue and few blood vessels, and are thus fairly anaerobic. Facultative anaerobes in bite wounds reduce available oxygen in the affected tissue, creating anaerobic conditions. Bite wounds result in the release of anaerobinases by keratinocytes; these convert oxygen to nitrogen, generating anaerobic conditions. Although anaerobes are introduced into a wound through biting, they do not multiply in the aerobic tissue and do not contribute to a bite wound infection. In fact, anaerobes are never involved in bite wound infections; tissues are always well oxygenated, which inhibits any anaerobes from multiplying in them. Choose one FALSE statement about the treatment of clostridial myonecrosis. Placing a person with gangrene in a hyperbaric chamber always eliminates the need for debridement and/or amputation. High doses of antibiotics, often a combination of penicillin and clindamycin, are given to help stop bacterial growth and toxin production. Prompt debridement of all dead and infected tissues is essential; in some cases amputation is also necessary. Antibiotic treatment of clostridial myonecrosis is challenging because antibiotics do not diffuse well into necrotic tissue. Antibiotic treatment of clostridial myonecrosis stops bacterial growth but has no impact on any toxin already produced by the causative agent.
Shaiju T.
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