Following a boating injury in an industrial-use river, a patient begins to display fever, tachycardia, and a rapidly expanding area of erythema, blistering, and drainage from a flank wound. An x-ray shows gas in the soft tissues. Which of the following measures is most appropriate?
Necrotizing skin and soft tissue infections may produce insoluble gases (hydrogen, nitrogen, methane) through anaerobic bacterial metabolism. While the term "gas gangrene" has come to imply clostridial infection, gas in tissues is more likely not to be caused by Clostridium species but rather to other facultative and obligate anaerobes, paicularly streptococci. Though fungi have also been implicated, they are less often associated with rapidly progressive infections. Treatment for necrotizing soft tissue infections includes repeated wide debridement, with wound reconstruction delayed until a stable, ble wound surface has been established. The use of hyperbaric O2 in the treatment of gas gangrene remains controversial, due to lack of proven benefit, difficulty in transpoing critically ill patients to hyperbaric facilities, and the risk of complications. Antitoxin has neither a prophylactic nor a therapeutic role in the treatment of necrotizing infections.
Administration of an antifungal agent
Administration of antitoxin
Wide debridement
Administration of hyperbaric O2
Miscellaneous