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Necrotizing Fasciitis Requires Rapid Diagnosis and Treatment

By Kristen Peña, DO; and Sarah Bella, DO, MPH | on October 16, 2018 | 0 Comment
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Kristen Pena and Sarah Bella

Necrotizing fasciitis is associated with a high mortality rate and should be treated immediately upon identification in the emergency department. Patients may present with different clinical histories and physical exam findings, but it is important that necrotizing fasciitis be ruled out in cases of rapidly progressive soft tissue infections.

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ACEP Now: Vol 37 – No 10 – October 2018

Dr. Peña is an emergency medicine resident at St. Joseph’s University Medical Center in Paterson, New Jersey.

Dr. Bella is an emergency medicine resident at Morristown Medical Center in Morristown, New Jersey.

Take-Home Points

  • Rapid recognition of necrotizing fasciitis should be considered in all rapidly progressive soft tissue infections.
  • Patients who present with skin infections and the risk factors immunosuppression, drug use, recent surgery, liver disease, traumatic wounds, and diabetes should be ruled out for a necrotizing fasciitis infection.
  • In addition to clinical suspicion, the LRINEC scoring system is a helpful tool that may guide provider management in patients presenting with rapidly progressive soft tissue infections.
  • CT scan is the most efficient diagnostic tool for necrotizing fasciitis in the emergency department.
  • Immediate treatment with antibiotic therapy and surgical debridement is vital to prevent rapid spread of this disease.

References

  1. Stevens DL, Baddour LM. Necrotizing soft tissue infections. UpToDate. Accessed September 27, 2018.
  2. Goh T, Goh LG, Ang CH, et al. Early diagnosis of necrotizing fasciitis. Br J Surg. 2014;101(1): e119-125.
  3. Wong CH, Chang HC, Pasupathy S, et al. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of morality. J Bone Joint Surg Am. 2003;85-A(8):1454-1460.
  4. Neeki MM, Dong F, Au C, et al. Evaluating the Laboratory Risk Indicator to differentiate cellulitis from necrotizing fasciitis in the emergency department. West J Emerg Med. 2017;18(4): 684-689.
  5. Wong CH, Khin LW, Heng KS, et al. Clinical relevance of the LRINEC (Laboratory Risk Index for Necrotizing Fasciitis) score for assessment of early necrotizing fasciitis. Crit Care Med. 2005;32(7):1535-1541.
  6. Panesar K. Necrotizing soft-tissue infections: “flesh-eating bacteria.” US Pharm. 2013;38(4):HS8-HS12.
  7. Misiakos EP, Bagias G, Papadopoulos I, et al. Early diagnosis and surgical treatment for necrotizing fasciitis: a multicenter study. Front Surg. 2017;4:5.
  8. Kleshinski J, Bittar S, Wahlquist M, et al. Review of compartment syndrome due to group A streptococcal infection. Am J Med Sci. 2008;336(3):265-269.
  9. Johnson P, Ocksrider J, Silva S. Update and review of acute compartment syndrome and necrotizing fasciitis. Intern Med Rev. 2017; 3(2).

Pages: 1 2 3 | Single Page

Topics: Acute Compartment SyndromeCase Reportsflesh-eating bacteriaflesh-eating diseaseLRINECNecrotizing Fasciitis

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