گاز گانگرن

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ad GAS GANGRENE 

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+ Itis a rapidly progressive, potentially fatal condition characterized by widespread necrosis of the muscles and subsequent soft-tissue destruction. ٠ This is a dreaded consequence of inadequately treated missile ‏یر‎ ‎crushing injuries and hig electrical injuries. 

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Causative agent * Clostribium species - spore forming, Gram +ve ‏و۳‎ ‏هه‎ 

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+ 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 5۱۸67 25 6 also been isolated in 60- 85% of cases of gas gangrene. 

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> foe تلایا لرروت ۲۰ . os \ Gas production \ In tissues } 4 > istension o' fToxemia and) 2 tissues ١ death @! interfering Blood supply os Ischemia/ 9 jangrene 

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Pathogenesis Examples of enzyme: ~_ colagenases, proteases and lipases 1 -These enzymes will kill other host cell and extend the anaerobic ۱ ‏وت‎ ‏۲6اه‎ 6 broken skin or wound Ua 0 0 توت یتنا کیت امع ‎Spores are‏ ات۱ ‎produced‏ ‎carbohydrate‏ ‎-The bacteria‏ مر رز ‎I‏ ان تارتین ery Rev ۲ et 

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Epidemiology —The persons at risk those with Diabetes Mellitus, blood vessel disease and colon cancer —Contact with contaminated cloth and other foreign material —Trauma or recent surgical wound 

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Colon cancer Patients with these diseases are more prone to developing gas gangrene Diabetes 

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Symptoms ۲ ۱ High fever \ 2 0 near ~ a Shock Massive tissue destruction Blackening of skin Severe pain around a skin of | ™ Blisters with gas bubbles form the infected area, the heartbeat and breathing b\ rapid. 

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Presentation Crepitation in tissues, sickly sweet odor discharge, rapidly progressing necrosis, fever, hemolysis, toxemia, shock, 

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سس د ها ها سد ع ع سه 6 ها - م > ها 

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م د ‎-z Pruner‏ م > وا 

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Prevention Cleaning the wound Avoid the contaminated material improve circulation in patients with poor cir antitoxin 

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Do a thorough wound toilet. In high risk wounds give the patient penicillin 1.5 megaunits 4 hourly, 

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Treatment * High doses of antibiotic : Penicillin * The dead tissue is removed or limbs are amputated * No vaccine 

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benzyl penicillin Or 0.5 g intravenously or 1g orally every 6 hours. Clostridia not sensitive to metronidazole, some other anaerobic bacteria are, so give it. 

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وی سوت we eee pee and not where clean cases go for operation. 

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SURGICAL TOILET AND DELAYED SUTURE A excise 2 mm of the skin edges. pack the wound with gauze and D 9 

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3 : es ۱۱ 6 ieee ۹ \ 2 Amputate under a 5 se the stump by 

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Myone x 

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1 i _ = Stump of above knee amputation : 7 

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* 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 to * Bacteriocidal effect, + Improves neutrophil function, * Enhanced wound healing