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24 Cards in this Set
- Front
- Back
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1. Necrotizing soft tissue infection (NSTI)?
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a. Soft tissue infection that affects primarily the dermis and subcutaneous tissue.
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2. Cellulitis?
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a. A milder form of soft tissue infection without the Association of microvascular thrombosis and necrosis
b. Clinically, patients do not have evidence of systemic toxicity and can be adequately treated with antibiotic therapy. |
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3. Initial antibiotic therapy for an NSTI?
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a. Should include broad-spectrum antibiotics directed against gram-positive, gram-negative, and anaerobic bacteria.
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4. Treatment of patients with necrotizing soft tissue infections?
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a. Following initial resuscitation, the patient should undergo examination of the leg with exploration of the subcutaneous tissue for infection and tissue viability.
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5. Systemic effects of NSTI?
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a. May include distant and organ dysfunction such as:
1. Acute renal insufficiency 2. Acute liver insufficiency b. Therefore most patients should be treated in the ICU with careful monitoring and maximal supportive care |
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6. With surgical debridement and exploration, what is indicated by easy separation of the subcutaneous tissue from the underlying fascia?
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a. Microvascular thrombosis and necrosis
b. Should be treated by tissue debridement. c. When identified, all necrotic tissue should be excised. |
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7. Note: it should be recognized that the absence of skin abnormalities is one of the leading factors contributing to delays recognition of a necrotizing soft tissue infections.
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7. Note: it should be recognized that the absence of skin abnormalities is one of the leading factors contributing to delays recognition of a necrotizing soft tissue infections.
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8. Typically the fascist serves as a natural barrier to the infectious process. However, which organism is likely to penetrate fascia?
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a. Clostridium species.
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9. In patients whose condition does not respond properly to support care, antibiotic therapy and surgical debridement, what may a lack of improvement indicate?
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a. The lack of improvement may be related to inadequate debridement and/or inappropriate antibiotic selection (source control).
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10. Early manifestations of soft tissue infection?
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a. Extension of edema beyond spread of erythema in severe pain.
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11. Late manifestations of soft tissue infection?
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a. Crepitation
b. Formation of skin vesicles c. Cutaneous anesthesia d. Focal necrosis |
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12. What tests are helpful in differentiating necrotizing soft tissue infections from Cellulitis?
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a. MRI and CT.
b. The diagnosis of NSTI in most cases can be established by clinical evaluation. |
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13. Soft tissue infection acquired after contact with fish or sea water, think of what species?
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a. Vibrio species
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14. Clinical manifestations of Vibrio species?
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a. Rapid progression of soft tissue infection
b. Fever c. Rigors d. Hypotension |
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15. Antibiotics used to treat Vibrio species?
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a. Ceftazidime
b. Plus c. Fluoroquinolone or tetracycline |
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16. Soft tissue infection: mixed synergistic infection; progression of perirectal infection or complications of gastrointestinal surgery, think of what species?
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a. Mixed gram-negative aerobes and anaerobes
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17. Clinical manifestations of Mixed gram-negative aerobes and anaerobes?
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a. Clinical progression over several days
b. May involve perinaeum and abdominal wall |
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18. Antibiotics used to treat Mixed gram-negative aerobes and anaerobes?
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a. Multiple regimens developed, gram-negative bacilli, and anaerobes
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19. Soft tissue infection: gas gangrene has complicated trauma or ischemia think of what species?
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a. Clostridial species
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20. Clinical manifestations of Clostridial species?
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i. Swollen, tense skin
ii. Crepitation iii. Skin vesicles b. Frequently present with systemic toxic therapy |
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21. Antibiotics used to treat Clostridial species?
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a. Penicillin (questionable benefit with hyperbaric therapy)
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22. Soft tissue infection: necrotizing soft tissue infection related to injection related to injectional drug use, “skin popping” think of what species?
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a. Clostridial species
b. Other gram-positive anaerobic organisms |
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23. Clinical manifestations of necrotizing soft tissue infection related to injection related to injectional drug use, “skin popping”?
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a. Swelling in systemic toxicity due to the release of exotoxins
b. As the injections are through the fascia and into the muscle during skin popping, the area of infection is in the muscles and below the fascia. c. These infections have very high mortality due to sepsis and organ failure |
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24. Antibiotics used to treat necrotizing soft tissue infection related to injection related to injectional drug use, “skin popping”?
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a. Penicillin
b. Clindamycin c. Vancomycin |
