NF and GG

 

Necrotising Fasciitis vs Gangrene

 

** REMEMBER TO ALWAYS DO RESUSCITATION FIRST PRIOR OTHER MANAGEMENT (ABX, ANALGESICS, DM CONTROL)

Indication for amputation: 3D's

🐣 Dying / diseased bone - PVD, infection, gangrene, trauma

🐣 Dangerous - lethal sepsis, malignant

🐣 Damn nuisance - gas gangrene, crush syndrome, severe malformation

Sample Xray

 Gas shadows seen extending from the foot up to upper calf 

Doppler 

Usually medical officer will ask for a doppler done and also ABSI. 

So try to get your doppler right. 

There are three spots that we must check : the Dorsalis Pedis Artery (DPA), Posterior Tibial Artery (PTA) and Brachial 

 

                   Normal ABSI: 1.0-1.3                                                    Normal wave: Triphasic

          ABSI 0.5-0.9: moderate to severe

ABSI >1.3: common in DM (may have severe calcifications)

Antibiotics:

For NF: commonly polymicrobial bacteria can be seen. 

• - IV Tazocin 4.5g QID (consist of piperacillin and tazobactem)
• - IV clindamycin 600-900mg  TDS 
• inhibitor of protein synthesis and protein  m synthesis 
• effective for gram +ve
• or Cefotaxime + metronidazole

 OTHERS:

• - unasyn (beta lactam, inhibiting bacterial cell wall synthesis)
• - ciprofloxacin : covers gram negative

Reference: 

Doppler PDF

Short terms;

- WD: wound debridement

- h/o : history of

- DM : Diabetes Mellitus

- DFU : Diabetes Foot Ulcer

- ABSI : Ankle Brachial Index