1/6. treatment outcome of nonclostridial gas gangrene at a Level 1 trauma center.OBJECTIVE: To evaluate the results of treatment of nonclostridial gas gangrene at a Level 1 trauma center. DESIGN: Retrospective. SETTING: Level 1 trauma center. patients: Seven patients with nonclostridial gas gangrene were studied. The average age of all patients at the time of admission was 40.3 years (range 14 to 67 years). RESULTS: Three of seven patients had posttraumatic infection, and the remaining four were strongly associated with underlying diseases: diabetes mellitus in three and paraplegia as the result of a spinal cord injury in two. The time of symptom onset was clearly defined in four cases, and the average interval between symptom onset and transfer to our hospitals was six days (range 2 to 10 days). Surgical debridement was performed immediately on admission in six patients (86 percent). A triple antibiotic regimen consisting of penicillin, gentamicin, and clindamycin was used initially in all patients. In three patients, hyperbaric oxygen therapy was also used. The overall mortality rate was 42.9 percent (three of seven patients). In these patients, the interval from onset of symptom to transfer to our hospital was ten days in one patient, which was longer than average, and was not accurately known in the other two patients. CONCLUSION: Nonclostridial gas gangrene is extremely rare but life-threatening. The greatest pitfall for the emergency department physician is failure to suspect it clinically. Aggressive treatment, including surgical debridement and intravenous antibiotics with or without hyperbaric oxygen therapy, must be initiated immediately to minimize morbidity and mortality.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. gas gangrene secondary to clostridium perfringens in pediatric oncology patients.OBJECTIVE: To report 2 cases of severe gas gangrene secondary to clostridium perfringens in pediatric oncology patients. methods: We describe 2 children with acute presentations of gas gangrene secondary to C. perfringens. Both children were initially seen and treated in a community hospital emergency department and subsequently were cared for in a pediatric intensive care unit in a tertiary care, university-based children's hospital. RESULTS: Both children demonstrated severe and unrelenting decompensation and required operative intervention within the first hospital day, which included amputation of the infected limb. One child survived and one child expired despite heroic measures. CONCLUSIONS: gas gangrene secondary to C. perfringens is an uncommon but life-threatening and limb-threatening condition in pediatric cancer patients. A high index of suspicion in a immunocompromised child with cancer who presents with extremity pain in combination with neutropenia is the key to early diagnosis and may lead to improved survival. This disease requires prompt recognition and aggressive treatment to allow any hope of recovery. emergency medicine physicians who treat these children should be aware of this severe and potentially fatal infectious process and should not delay treatment or prompt orthopedic surgery consultation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/6. Nonclostridial gas gangrene.Although nonclostridial gas gangrene is not an unusual occurrence, relatively few cases including the distal lower extremity have been reported. Due to the serious nature of some of these infections, it is important for physicians to familiarize themselves with these nonclostridial crepitant infections, which are often confused with clostridial myonecrosis. Etiology, evaluation, and treatment is described by the authors. Also, a case study is presented.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/6. Nonclostridial gas gangrene.Podiatric physicians must realize that the presence of crepitus, and/or radiographic evidence of gas in the subcutaneous tissue, does not necessarily mean anaerobic clostridial gas gangrene. This is especially true in the diabetic where other gas producing organisms have been isolated. The authors provide a literature review, and case study, of nonclostridial gas gangrene.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/6. gas gangrene from subcutaneous insulin administration.A case of gas gangrene that caused intractable shoulder pain refractory to narcotics in an immunocompromised host is presented. gas gangrene has been associated with severe trauma involving penetrating wounds, compound fractures, extensive soft-tissue injury, intramuscular injection of epinephrine, and interruption of arterial blood supply. This case describes an elderly insulin-dependent diabetic woman who developed gas gangrene in her arm and leg at the site of her subcutaneous insulin injections. The responsible organism was clostridium septicum. emergency medicine physicians must consider gas gangrene Clostridium infection in immunocompromised individuals without evidence of trauma who present with localized and intractable pain.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/6. gas gangrene: potential for hyperbaric oxygen therapy.Clostridial myonecrosis (gas gangrene) is an uncommon sequela of traumatic injury. infection with clostridium perfringens in devitalized tissue is the most common cause. Wide surgical debridement and appropriate antibiotic therapy remain the standard of care. However, the addition of hyperbaric oxygen therapy to standard management has been shown to have a synergistic effect in reducing morbidity and mortality in both canine and murine models. Although no prospective human data are available, retrospective data indicate that concomitant hyperbaric oxygen therapy has resulted in a twofold reduction in mortality. Where feasible, hyperbaric oxygen therapy should routinely be incorporated into the treatment plan for gas gangrene. Primary care physicians are in a unique position not only to make an early diagnosis but also to have a central role in coordinating multidisciplinary care often needed for this potentially fatal infection.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |