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Gangrene, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Gas gangrene or clostridial myonecrosis

  • An acute, rapidly progressive, gas-forming necrotizing infection of muscle and subcutaneous tissue

  • Can be seen in post-traumatic or postoperativ...

Diagnosis

Signs and Symptoms

  • Sudden severe pain of extremity or involved area

  • Low-grade fever

  • Tachycardia out of proportion to fever

  • Bronzing of the skin over involved area; later can turn purple or red

  • Cr...

Treatment

Pre-Hospital

Establish IV and infuse isotonic fluids 

Initial Stabilization/Therapy

Manage airway and resuscitate as indicated: 
  • Rapid sequence intubation as needed.

  • Supplemental oxygen:

    • Cardiac a...

Follow-Up

Disposition

Admission Criteria

  • All patients with gas gangrene and evidence of myonecrosis must be admitted for surgical débridement and IV antibiotics.

  • Use of HBO therapy is an important adjunc...

Pearls and Pitfalls

  • Bacteremia occurs in about 15% and can progress quickly to intravascular hemolysis.

  • HBO as adjunctive therapy to surgical débridement and early antibiotics if patient is hemodynamic...

Additional Reading

  • Bakker  DJ. Clostridial myonecrosis (gas gangrene). Undersea Hyperb Med.  2012;39(3):731–737.

  • Bryant  AE, Stevens  DL. Clostridial myonecrosis: New insights in pathogenesis and ...

Codes

ICD9

  • 040.0 Gas gangrene

  • 785.4 Gangrene

ICD10

  • A48.0 Gas gangrene

  • I96 Gangrene, not elsewhere classified

SNOMED

  • 372070002 Gangrenous disorder (disorder)

  • 80466000 Gas gangrene (disorder)

  • 266093005 Gas gangr...

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