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Necrotising fasciitis - Coggle Diagram
Necrotising fasciitis
Definition
Fulminant bacterial infection
Deep fascia and subcutaneous fat
rapid spread through facial planes
interuption of circulation
Vascular thrombosis
local necrosis
cutaneous ischaemia
Destruction of superficial nerves
Loss of sensation
Management
Conservative
VAP bundle
Bowel bundle
Lung protective ventilation
Hyperbaric oxygen therapy
Medical
Antibiotics
clindamycin
turns off endotoxin production
IVIG
induces antibodies against endotoxin
Neutralises superantigens
Inhibits membrane attack complex C5b
Prevents complement activation
Surgical
Exploration
Debridement
Re-look
Classification
Dermatological
Stage 1
erythema
tenderness extending beyond
Stage 2
skin bullae
blisters
fluctuant skin
Stage 3
haemorrhagic bullae
crepitus
skin necrosis
Gangrene
Microbiological
Polymicrobial 70%
Gram +ve
cocci
bacilli
Gram -ve
bacilli
anaerobes
clostridium
bacteriodes
Group A strep (GAS) 20%
Strep pyogenes
+/- staph aureus
Gram Negative monomicrobial 10%
Vibrio
Fungal (Rare)
Candida
Scoring system
Laboratory Risk Indicator for NF (LRINEC)
6 lab categories
Scored 0, 1, 2, 4
Score >6 PPV 92%