male pt age54 came with swelling and redness over rt upper and lower limb since a week ago, gradually progressing.. lab investigation shows platelet 37000. tlc 19000 hb9.8 Chronic HTN, Non diabetic. whts course of management?



Is there any h/o trauma? There is ulceration with cellulitis affecting whole of the limb. May be necrotising fascitis as mentioned by Dr. Golam which is usually fast spreading. Start on i.v. antibiotics, daily dressing, send pus for c/s and limb rest. Sepsis induced thrombocytopenia is present still Hematological opinion for low platelet count should be taken to rule out any other possibility

sir there is h/o trauma to arm 2days back

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This is cellulitis, consider necrotising fascitis too. Non diabetic, so please look out for an immunocompromised status. With such high TC he is in sepsis + anemia and thrombocytopenia. Needs fresh/ whole blood transfusion, followed by an emergency decompression and debridement along with culture specific antibiotics. One needs to be fairly aggressive in managing such cases, failing which would result in dire consequences, there is no room for wait and watch policy.

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thank u curofy

? Post traumatic cellulitis leading to Necrotising fasciitis H/O..HT with thrombocytopenia & leucocytosis Needs to investigate briefly with septic wond management Experts opinion is useful

This patient should be evaluated for disbetes and should be given IV antibiotics for 7-10 days with pressure dressings

Why pressure dressing sir? Please don't take otherwise. Just want to know.

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Cellulitis after trauma Strict dm conrtoll X-ray for deep injury-as may b hairline #causing oozing and not controlling sepsis Higher antibiotic iv Pressure bandage on elevation of limb

? Necrotising fasciitis (early stage) /Cellulitis with ulceration

It's a case of cellulitis with necrotizing fascitis.

I m agree with u

As the pt is in older and after h/o trauma the swelling and redness increasing within one week but pt presenting only in RT side both upper and lower limb not in left side from this pts decubitus in RT lateral possibility is there if it's the actual case may be pt was suffering from CCF with pleural effusion in RT >Lt associated with CKD this pts are prone to infections leading to septicemia which intern increase WBC count and decrease of platelet count due to DIC ,if pt is on long term aspirin due to cardiac disease then that must be avoided as more chance of capillary hge . Peripheral blood smear along with LFT ,KFT ,GFR,,sugar F&PP ,urine for RE /ME ,cxr pa ,ECho cardio graphy ,USG abd must be done to proper diagnose the disease ,pt is Tobe stabilised by broad spectrum antibiotics ,platelet transfusions ,close monitoring by observing vital signs and 24 HR urine output is to be measured ,after stabilisation of pt bone marrow aspiration biopsy may be needed to exclude heamatopoeitic disorders.

Necrotising fasciitis c Cellulitis

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