A 64yrs/m patient admitted in our hospital with h/o:- swelling

A 64yrs/M Patient admitted in Our Hospital with H/O:- Swelling on left leg..No H/O:- Diabetes. K/C/O of Hypertension with Moderate Obesity. Medication H/O:-Tab Amlo-AT,Tab Ecosprin 75,Tab Envas 5mg. L/E:-Cellulitis with ? Phileriasis. Pus C/S sent to lab. Started On Inj Tazaar 4.5gms q8hrsly, Tab Banocide Forte q8hrsly. Lab:-TLC 15,500,BSL 95. Tomorrow posted for Cleaning & Debridement under GA. Any Suggestions.. Regards.

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Necrotising fascitis.. Do thorough debridement and lavage of the wound followed by dressings.. Send CBC, biochemistry, PBS for toxic granules.. Add metronidazole and another good gram negative cover like amikacin if renal function is ok..

Don't forget to keep the limb elevated Clindamycin will be better instead of metro
5

Lymphangitus, inflammation of subcutaneous and deep fascia and presence of bullae indicate streptococcal group A organism infection. Not cellulitus as there is clear cut demarcation is which is absent in cellulitus. Pointing out towards erysipelas / necrotising fascitis.

Necrotizing fascitis Treat with extensive debridement and antibiotics. Exclude risk factors and treat adequately.

Acute lymphangitis with necrotising fascitis. Multiple incision fasciotomy and excision of necrotic tissue with regular dressing undercover of Tazobactwithpipra 4.5gm iv bid with clindamycin.keep leg elevated.

I agree with Dr R Prabhakar& Dr.S Verma

Lymphangitus, inflammation of subcutaneous and deep fascia and presence of bullae indicate streptococcal group A organism infection. Not cellulitus as there is clear cut demarcation is present. Pointing out towards erysipelas / necrotising fascitis

Multiple Incisions fasciotomy and excision of necrotic tissue and Antibiotics are necessary

I think there has to be a gap of at least 2 to 3 days before doing any surgical intervention and stoppage of aspirin,.,.,!

This is a life threatening cellulitis.piperacillin tazobactam is a good choice.patient needs to be evaluated for sepsis syndrome tachycardia;RR; BP.good to get his creatinine and electrolytes immediately.ECG also. Can stop envas temporarily Monitor the sugars pre and post meal and if nill by mouth every 2hrly He should be on basal bolus insulin

Eryseplas. Do ASO titer . Injection crystalline penicillin 1o lac units 6 hrly. Elevate the part .

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