Monday, September 3, 2018

Necrotizing Fasciitis

TAMING THE SRU - September 03, 2018 - By Berger B
  Figure 1 - Skin Findings of Advanced Necrotizing Fasciitis.  (By Piotr Smuszkiewicz, Iwona Trojanowska and Hanna Tomczak [CC BY 2.0 (], via Wikimedia Commons)
The LRINEC score is not recommended to bear much weight in the decision making surrounding suspected necrotizing fasciitis. As the LRINEC authors themselves state, “it should be emphasized that the diagnosis of necrotizing soft tissue infections is a clinical diagnosis, and this diagnosis or even suspicion of it warrants immediate operative debridement.” Good advice.
Mentioning that someone’s LRINEC score is 10 is not a bad way to let your surgery friend know that you are highly concerned and it’s time to trot to the ED, but a LRINEC score of 2 won’t prevent the same urgent consult in someone with dodgy blood pressure, an excruciatingly painful leg with violaceous coloring, and a history of diabetes. Clinical suspicion is the cornerstone of this diagnosis.
So, if your patient with a soft tissue infection has any of…
  • Pain out of proportion to their examination
  • Pain or edema outside of the area of erythema
  • Systemic illness (tachypnea, hypotension, tachycardia, altered mentation)
  • Bullous, necrotic, or ecchymotic lesions
  • A rapidly progressing course
…then it’s likely time to consider advanced imaging and surgical consultation to move the patient toward life-saving treatment."