62 year old male patient , no known comorbids , presented to ER with h/o drowsy ness since morning with profuse sweating and cold peripherals On arrival Pt-drowsy arousable Bp-40/20 Pulse- not recordable Swollen scrotum and enlarged testicles with redness and skin avulsion GRBS-143mgdl Chest -clear Any DDs and management?

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FOURNIER 'S GANGRENE, a classical presentation of acute Surgical emergency where mortality is very high. As B.P is 40 / 20 , drowsy, pulse not recordable indicative of septic shock . Resuscitate the patient. Start IV fluids, Dopamine drip, catheterise the patient., Correct dehydration and electrolytes , maintain input output chart, start CVP line , parenteral antibiotics inj Piperacillin 4 gm+ tazobactum 500 mg × 6 hourly, hyperbaric oxygen After 4- 6 hours of stabilisation. Shift to O.T and do debridement adequately. Achieve strict glycemic control if diabetic with insulin . Later on SSG may be required and testis may be implanted in a subcutaneous pouch created in inner side of upper thigh

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Fournier's Gangrene a type of necrotizing fasciitis or gangrene affecting the external genitalia and or perineum... It is more likely to occur in diabetics, alcoholics, or those who are immunocompromised. It is a urological emergency requiring intravenous antibiotics and debridement(surgical removal) of necrotic (dead) tissue.In addition to surgery and antibiotics, hyperbaric oxygen therapy may be useful and acts to inhibit the growth of and kill the anaerobic bacteria.

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Fournier gangrene Type of facial/ anaerobic infection Urgent debridement Oxygen therapy Parentral antibiotics Dressing SSG as required

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Most probably Septicemia due to Fournier's Gangrene. Though more commonly occurs in Diabetics & immune compromised pt, it may occur in any. Management includes management of Septic Shock, & Debridement of scrotum. Once extensive Debridement is done, pt improves rapidly. Later on, after full general recovery & local healthy wound; further management of wound

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First manage the circulatory failure Give bolus iv fluids Inotropic support to stabilise the pressure Abg Start broad spring antibiotic Metrog

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Forniers gangrene a type of necrotising fascitis or gangrene affecting the external genitalia and or perineum

Manage first the circulatory failure Give bolus I've fluids. Inotropic support to stabilize the pressure And.

Fourrniers Gangrene with septic shock . . Iv fluids, iv antibiotics, inotrops, CBC, KFT, surgical debriment of dead necrotic tissue , correct Acidosis if any on ABG

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First treat the shock then go ahead with surgical procedure

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