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Necrotizing Fasciitis

Necrotizing Fasciitis. Justina Du, Thao Nguyen, Camille Thorsen. What is Necrotizing Fasciitis?. life-threatening, progressive, rapidly spreading, inflammatory infection located in the deep fascia. infection rapidly destroy the skin and soft tissue beneath it

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Necrotizing Fasciitis

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  1. Necrotizing Fasciitis Justina Du, Thao Nguyen, Camille Thorsen

  2. What is Necrotizing Fasciitis? • life-threatening, progressive, rapidly spreading, inflammatory infection located in the deep fascia. • infection rapidly destroy the skin and soft tissue beneath it • Also known as: “flesh-eating” bacteria. • Other names: β-hemolytic streptococcal gangrene, Meleney ulcer, acute dermal gangrene, hospital gangrene, and necrotizing cellulitis. • 3 types of NF. • Type I : a polymicrobial flora. • Type II Group A β-Streptococcus bacteria(most common case) • Type III : marine vibrio gram-negative rods.

  3. How does one contract NF? • exposed to an individual with an opening in their skin. • direct contact with someone carrying the bacteria • the bacterium being carried by the person itself. • sight of entrance can be as minor as a paper cut or a pin prick. • enter through weakened skin, as a contusion, a bruise, a blister, or even an abrasion. • Can happen to anyone!!!!!!

  4. Cofactors that Increase risks • Diabetes • Alcoholism • Immuno-suppression • Severe illnesses: heart, lung, or liver disease • Obesity

  5. What’s going on inside your body? • Bacteria eat away at tissue between skin and muscle • Increase in sensitivity or anaesthetic feel to the skin itself • Inflammatory response by immune system • Bacterial toxins released • Cytokines impede function of phagocytic cells • Anaerobes thrive speeding up necrotic process • Endothelial cells become damaged; • Increased permeability of the lining of vessels in the body • Poor blood supply inhibit: • Inflammatory response process • Ability for the immune system to properly work • Ability to transfer antibiotics to the affected fascial layer • Vasoconstriction and thrombosis  edema  hypoxia  necrosis of the fascia, skin, soft tissue, and muscles. • Additional necrosis involving the subcutaneous nerves.

  6. What are the early symptoms and signs of NF? • Flu like symptoms that include fever, chills, nausea, weakness, dizziness, aches and a heat rate of more than 100 beats per minute. • Skin becomes tender, warm, red in color, and will start to swell. • Patients may experience pain greater than expected from the appearance of the wound. • Subcutaneous tissue may also have a hard feel on palpation that goes past the visibly infected area. • Clinically indistinguishable from other possible soft tissue infections with only the presentation of pain, tenderness, and warm skin.

  7. Advanced symptoms… • The advanced symptoms appear as the disease progresses • The area of the body experiencing pain begins to swell excessively. • Multiple discolored patches develop to produce a large area of gangrenous skin. • Initial necrosis appears as a massive destruction of the skin and subcutaneous layer. • The normal skin andsubcutaneous tissue are loosened. • Large, dark marks that become blisters filled with a yellow-green necrotic fluid appear.

  8. Critical symptoms… • The critical symptoms form in the last stages of NF. • 30% of patient’s develop hemorrhagic bullae which may cause them to become anemic. • Vasculature of the skin becomes inflamed and thrombosed. Resulting in necrotic eschars that look like deep thermal burns. • Without treatment, secondary involvement of deeper muscle layers may occur. • Patients may become numb because of nerve damage and progressing gangrene in the infected area. • Unconsciousness will occur as the body becomes too weak to fight off the infection along with a severe decrease in the patient’s blood pressure. • As toxins are being released, the body’s organ may go into septic shock while contracting a high fever, high white blood count, and becoming disoriented. This may result into respiratory failure, heart failure and renal failure.

  9. Exams and Laboratory Testing • In order to get a definitive diagnosis of NF, physicians look for abnormalities in the test results that are characteristics of the disease. • Some of these tests include: 1. Blood samples 2. Testing for elevated or lowered creatinine, glucose, CPK, bicarbonate, albumin, and calcium levels. 3. X-ray 4. CT, and MRI scanning 5. And most importantly antibiotic culture and sensitivity tests

  10. Treating NF • Early diagnosis and treatment is vital • Emergency debridement • IV antibiotic treatment • Hyperbaric oxygen therapy is recommended for anaerobic organisms • Morphine drip and a patient-controlled analgesia pump to control pain • Soft tissue reconstruction • Monitor nutrition • If sepsis has set in, vasoconstricting medications should be given. • Education and counseling

  11. PREVENTION!!! • Most people are in good health before they become infected. • Degrees to lessen your chances • basic hygienic practices (washing hands), • keep all wounds clean, • watch for signs of infection (increase pain, swelling, pus, heat or fever), • seek immediate medical attention if have symptoms of flesh-eating disease, and • have precaution if in close contact with someone with the bacteria.

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