گاز گانگرن

گاز گانگرن

اسلاید 1: GAS GANGRENE

اسلاید 2: It is a rapidly progressive, potentially fatal condition characterized by widespread necrosis of the muscles and subsequent soft-tissue destruction. This is a dreaded consequence of inadequately treated missile wounds, crushing injuries and high-voltage electrical injuries.

اسلاید 3: Causative agentClostribium species – spore forming, Gram +ve

اسلاید 4: They are present in the soil and have also been isolated from the human gastrointestinal tract and female genital tract.Non-clostridial gas-producing organisms such as coliforms have also been isolated in 60–85% of cases of gas gangrene.

اسلاید 5: Anaerobic environmentDistension oftissuesInterferingBlood supplyIschemia/gangreneToxemia anddeathSpores germinateCarbohydratesFermentation Gas productionIn tissues PATHOGENESISIncubation period is 1-7 daysvegetative cells multiply

اسلاید 6: Pathogenesis

اسلاید 7: EpidemiologyThe persons at risk those with Diabetes Mellitus, blood vessel disease and colon cancerContact with contaminated cloth and other foreign materialTrauma or recent surgical wound

اسلاید 8:

اسلاید 9: SymptomsHigh feverShockMassive tissue destructionBlackening of skinSevere pain around a skin of woundBlisters with gas bubbles form near the infected area, the heartbeat and breathing become rapid.

اسلاید 10: Crepitation in tissues,sickly sweet odor discharge,rapidly progressing necrosis,fever, hemolysis, toxemia, shock,renal failure, and deathPresentation

اسلاید 11:

اسلاید 12:

اسلاید 13: Culture and sensitivityStorming fermentationLecithinase testLab. Investigations

اسلاید 14: GAS IN SOFT TISSUE

اسلاید 15: GAS IN UTERUS

اسلاید 16: GAS IN UTERUS

اسلاید 17: GAS IN UTERUS

اسلاید 18: Prevention Cleaning the woundAvoid the contaminated materialimprove circulation in patients with poor circulationantitoxin

اسلاید 19: (1) Do a thorough wound toilet.(2) In high risk wounds give the patient penicillin 1.5 megaunits 4 hourly, or tetracycline Prevention

اسلاید 20: Treatment High doses of antibiotic : PenicillinThe dead tissue is removed or limbs are amputatedNo vaccine

اسلاید 21: 10 megaunits of benzyl penicillin daily for 5 days as four 6 hourly doses. OrTetracycline 0.5 g intravenously or 1 g orally every 6 hours. Clostridia not sensitive to metronidazole, some other anaerobic bacteria are, so give it.

اسلاید 22: Do this in a septic theatre, or even in the out-patient department, and not where clean cases go for operation. EXPLORATION

اسلاید 23:

اسلاید 24: AMPUTATION Amputate under a tourniquet Close the stump by delayedprimary suture

اسلاید 25: Myonecrosis of right leg

اسلاید 26: Myonecrosis of left foot

اسلاید 27: Stump of above knee amputation

اسلاید 28: Patients should be admitted to ICU and treated aggressively with careful monitoring. The role of HBO is not as clear as in necrotising fasciitis but it is recommended in severe cases if the facilities are available.increases the normal oxygen saturation in the infected wounds by 1000-fold leading toBacteriocidal effect, Improves neutrophil function, Enhanced wound healing