• Prompt surgical consultation is recommended for patients with aggressive infections associated with signs of systemic toxicity and suspicion for necrotizing fasciitis.
• Empiric antibiotic treatment should be broad and initiated early.
• The LRINEC is a useful diagnostic adjunct in management to stratify patients who in the low, medium and high risk categories to aid in clinical management.
• Goal as an ED physician is to identify these patients, aggressively resuscitate them and get surgery involved quickly.
- old, DM, ETOH, immunocompromised, systemic disease (renal, heart, PVD)
- Microbial cause (polymicrobial [type I = most common], monomicrobial [type 2 = strep & staph], vibrio [type 3])
- nec fas is a clinical diagnosis
> Pain at site of infection
> Blisters/ bullae
> Vital sign abnormalities
- CRP, WBC, Hgb, Na, Cr, Glucose
> Low (<5) - prob < 50%, intermediate (6-7) prob 50-75%, High (>8) prob >75%
- basic labs, imaging - US, plain films, CT - 80% sensitive, MRI
- Antibiotics - PCN & Clindamycin (group A strep) - but cover broadly - vanc + zosyn
Teaching points from our surgical colleagues
1. Early diagnosis
2. Early & extensive surgical intervention
3. Life over limb