What is the difference between gas gangrene and gangrene

Some have advocated that patients with a NSTI should receive care in a burn center, but it is unclear as to whether or not this decreases mortality. It is essential to immediately start broad-spectrum antibiotic therapy that provides adequate coverage for the most likely causative organisms. Antibiotic therapy may be eventually discontinued, that is, several days after the last surgical debridement has been performed.

Currently, there are no established guidelines that specify the optimal length of treatment with antibiotic therapy. For patients with type II NSTI who develop streptococcal toxic shock syndrome, which is associated with increased capillary permeability and hypotension, there may be a need for the very aggressive administration of IV fluids, that is liters per day , and pressor support may also be required.

It is important to be aware that the use of either epinephrine or norepinephrine in this setting may be associated with the development of symmetrical gangrene. Since it is not widely available, and has not been well-studied, there is only limited evidence to support the use of HBO for the treatment of NSTI.

Some patients with NSTI may develop respiratory failure, and then will require mechanical ventilation. Initially admitting the patient to the intensive care unit ICU should be strongly considered, to allow for close monitoring of his or her hemodynamic status. Nutritional support in the form of supplemental enteral or parenteral nutrition is essential for patients with a NSTI, and this should be provided as soon as the patient is hemodynamically stable.

Postoperative wound management will be necessary after the patient undergoes surgical debridements. The placement of split-thickness skin grafts, full-thickness skin grafts, or temporary skin substitutes such as cadaveric skin allografts or porcine skin xenografts may be necessary, if the postoperative wound is not suitable for primary closure.

Broad-spectrum antibiotics must be started immediately in the emergency department. Appropriate antibiotic coverage for adults with NSTIs is indicated below:. Anaerobic coverage must be provided, since the infection is usually polymicrobial. Empiric antibiotic therapy options are:. Careful assessment of the areas that have been surgically debrided is important, to ensure that the NSTI or gas gangrene has been adequately treated. If there are any skin areas that are concerning, then the surgeon should be advised about this, since the patient may require another debridement procedure.

Since intravascular hemolysis can occur in bacteremic patients with traumatic gas gangrene, they require a daily CBC, until repeat blood cultures become negative.

Long-term management of the NTSI or gas gangrene, that is, after the patient has undergone surgical debridement procedures, would most likely be coordinated by the surgeon. This is because the patient may have extensive surgical wounds, for which a skin graft or temporary skin substitute may be needed for closure. Surgical follow-up would be necessary to ensure that these wounds are adequately addressed. Urgent surgical consultation is required for patients suspected of having either a NSTI or Clostridial myonecrosis gas gangrene.

Do not delay surgical evaluation pending imaging studies. Antibiotic therapy must be started immediately for patients with either a NSTI or Clostridial myonecrosis gas gangrene. Renal Insufficiency. The antibiotics that are administered for the treatment of the NSTI or gas gangrene Clostridial myonecrosis would need to be renally dosed.

Since patients with NSTI and gas gangrene often require fluid resuscitation, care would need to be taken to avoid the development of acute decompensated heart failure, as a result of the aggressive administration of IV fluids. Sign-out considerations While Hospitalized.

Careful monitoring of all surgically debrided areas is important to ensure that evidence of a NSTI does not recur. This would be an indication for the patient to promptly undergo additional surgical debridement. Monitor the hemoglobin in a bacteremic patient with traumatic gas gangrene Clostridial myonecrosis , since intravascular hemolysis may develop and is associated with increased morbidity and mortality. A patient who presents with a NSTI or gas gangrene Clostridial myonecrosis will likely require multiple surgical debridements, and often requires stabilization in the ICU during his or her hospital admission.

There is no evidence that a NSTI or gas gangrene Clostridial myonecrosis is still present, including no signs of systemic toxicity. When should clinic follow up be arranged and with whom? Surgical follow-up within 1 week, for monitoring of the wounds that resulted from surgical debridements. If the patient required extensive surgical debridements for treatment of the NSTI or gas gangrene Clostridial myonecrosis , then placement in an LTAC or SNF, that is equipped to properly manage complex wounds, may be necessary.

Patient Safety and Quality Measures. Core Indicator Standards and Documentation. The importance of appropriate wound care for the wounds that developed as a result of surgical debridement, need to be stressed to the patient. Doing so may help to reduce the likelihood that an infection will develop at these sites.

J Foot Ankle Surg. Hussein, Q, Anaya, D. Crit Care Clin. Mullangi, P, Khardori, N. Med Clin N Am. Clin Infect Dis. J Intensive Care Med. J Trauma. Ustin, J, Malangoni, M. Crit Care Med. This is a nonsurgical alternative to traditional debridement. During this procedure, clean fly larvae are placed on the affected area to eat away dead tissue and remove bacteria. This is a painless procedure. Hyperbaric oxygen therapy. During this procedure, you are placed in a special pressurized chamber that administers oxygen at high pressures, forcing more oxygen into the affected area.

This can promote speed healing and help kill bacteria. This treatment is especially effective in people who develop gangrene from diabetic foot ulcers. Vascular surgery. If your gangrene is caused by poor blood flow, your healthcare provider may recommend surgery to improve your circulation. People whose gangrene is a result of a blocked artery, for example, may have bypass surgery or an angioplasty to fix the problem.

What are the complications of gangrene? Treating these large areas may result in: Large areas of scarring The need for reconstructive surgery Amputation Severe cases of gangrene may lead to organ failure and even death. What can I do to prevent gangrene? When should I call my healthcare provider? Key points Gangrene is a dangerous and potentially fatal condition that happens when the blood flow to a large group of tissues is cut off.

Symptoms of gangrene include coldness, numbness, pain, redness, or swelling in the affected area. Amputation is sometimes needed. Next steps Tips to help you get the most from a visit to your healthcare provider: Know the reason for your visit and what you want to happen. Before your visit, write down questions you want answered. Bring someone with you to help you ask questions and remember what your provider tells you.

At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you. Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are. Ask if your condition can be treated in other ways. Gangrene is a serious condition and needs emergency treatment. Call your doctor right away if you have persistent, unexplained pain in any area of your body along with one or more of the following signs and symptoms:.

Gangrene results when blood flow to a certain area of your body is interrupted, causing tissue decay and death. Gangrene often affects the fingers or toes. Wet gangrene. Gangrene is referred to as wet if there's a bacterial infection in the affected tissue.

Swelling, blistering and a wet appearance are common features of wet gangrene. Wet gangrene may develop after a severe burn, frostbite or injury. It often occurs in people with diabetes who unknowingly injure a toe or foot. Wet gangrene needs to be treated immediately because it spreads quickly and can be deadly. Gas gangrene. Gas gangrene typically affects deep muscle tissue.

If you have gas gangrene, the surface of your skin may look normal at first. As the condition worsens, your skin may become pale and then turn gray or purplish red. The skin may look bubbly and may make a crackling sound when you press on it because of the gas within the tissue. Gas gangrene is most commonly caused by infection with a bacterium called Clostridium perfringens. Bacteria gather in an injury or surgical wound that has no blood supply. The bacterial infection produces toxins that release gas and cause tissue death.

Like wet gangrene, gas gangrene is a life-threatening condition. Internal gangrene. Gangrene that affects one or more of your organs, such as your intestines, gallbladder or appendix, is called internal gangrene. This type of gangrene occurs when blood flow to an internal organ is blocked — for example, when your intestines bulge through a weakened area of muscle in your stomach area hernia and become twisted.