fasciitis santa monica college坏死性筋膜炎圣莫尼卡学院课件

Necrotizing Fasciitis,Justina Du, Thao Nguyen, Camille Thorsen,What is Necrotizing Fasciitis?,life-threatening, progressive, rapidly spreading, inflammatory infection located in the deep fascia. infection rapidly destroy the skin and soft tissue beneath it Also known as: “flesh-eating” bacteria. Other names: -hemolytic streptococcal gangrene, Meleney ulcer, acute dermal gangrene, hospital gangrene, and necrotizing cellulitis. 3 types of NF. Type I : a polymicrobial flora. Type II Group A -Streptococcus bacteria (most common case) Type III : marine vibrio gram-negative rods.,How does one contract NF?,exposed to an individual with an opening in their skin. direct contact with someone carrying the bacteria the bacterium being carried by the person itself. sight of entrance can be as minor as a paper cut or a pin prick. enter through weakened skin, as a contusion, a bruise, a blister, or even an abrasion. Can happen to anyone!,Cofactors that Increase risks,Diabetes Alcoholism Immuno-suppression Severe illnesses: heart, lung, or liver disease Obesity,Whats going on inside your body?,Bacteria eat away at tissue between skin and muscle Increase in sensitivity or anaesthetic feel to the skin itself Inflammatory response by immune system Bacterial toxins released Cytokines impede function of phagocytic cells Anaerobes thrive speeding up necrotic process Endothelial cells become damaged; Increased permeability of the lining of vessels in the body Poor blood supply inhibit: Inflammatory response process Ability for the immune system to properly work Ability to transfer antibiotics to the affected fascial layer Vasoconstriction and thrombosis edema hypoxia necrosis of the fascia, skin, soft tissue, and muscles. Additional necrosis involving the subcutaneous nerves.,What are the early symptoms and signs of NF?,Flu like symptoms that include fever, chills, nausea, weakness, dizziness, aches and a heat rate of more than 100 beats per minute. Skin becomes tender, warm, red in color, and will start to swell. Patients may experience pain greater than expected from the appearance of the wound. Subcutaneous tissue may also have a hard feel on palpation that goes past the visibly infected area. Clinically indistinguishable from other possible soft tissue infections with only the presentation of pain, tenderness, and warm skin.,Advanced symptoms,The advanced symptoms appear as the disease progresses The area of the body experiencing pain begins to swell excessively. Multiple discolored patches develop to produce a large area of gangrenous skin. Initial necrosis appears as a massive destruction of the skin and subcutaneous layer. The normal skin and subcutaneous tissue are loosened. Large, dark marks that become blisters filled with a yellow-green necrotic fluid appear.,Critical symptoms,The critical symptoms form in the last stages of NF. 30% of patients develop hemorrhagic bullae which may cause them to become anemic. Vasculature of the skin becomes inflamed and thrombosed. Resulting in necrotic eschars that look like deep thermal burns. Without treatment, secondary involvement of deeper muscle layers may occur. Patients may become numb because of nerve damage and progressing gangrene in the infected area. Unconsciousness will occur as the body becomes too weak to fight off the infection along with a severe decrease in the patients blood pressure. As toxins are being released, the bodys organ may go into septic shock while contracting a high fever, high white blood count, and becoming disoriented. This may result into respiratory failure, heart failure and renal failure.,Exams and Laboratory Testing,In order to get a definitive diagnosis of NF, physicians look for abnormalities in the test results that are characteristics of the disease. Some of these tests include: 1. Blood samples 2. Testing for elevated or lowered creatinine, glucose, CPK, bicarbonate, albumin, and calcium levels. 3. X-ray 4. CT, and MRI scanning 5. And most importantly antibiotic culture and sensitivity tests,Treating NF,Early diagnosis and treatment is vital Emergency debridement IV antibiotic treatment Hyperbaric oxygen therapy is recommended for anaerobic organisms Morphine drip and a patient-controlled analgesia pump to control pain Soft tissue reconstruction Monitor nutrition If sepsis has set in, vasoconstricting medications should be given. Education and counseling,PREVENTION!,Most people are in good health before they become infected. Degrees to lessen your chances basic hygienic practices (washing hands), keep al