tag:blogger.com,1999:blog-2760353953251845523.post6509222337064126451..comments2024-02-10T02:14:39.898-05:00Comments on Buckeye Surgeon: Necrotizing Soft Tissue InfectionJeffrey Parks MD FACShttp://www.blogger.com/profile/15650563299849196122noreply@blogger.comBlogger11125tag:blogger.com,1999:blog-2760353953251845523.post-44229424078736362322010-01-29T00:38:32.255-05:002010-01-29T00:38:32.255-05:00I'm still recovering from my necrotizing fasci...I'm still recovering from my necrotizing fasciitis in my right arm. It took three days to diagnose. I didn't get my CT until about an hour before the surgeon decided to operate. This was in November; I still have an open wound. On Feb. 12th, I'm getting the contracture in that arm fixed, and getting Integra applied to prepare for a skin graft. I have pics of the wound online.Dr. Mongo Lloydhttps://www.blogger.com/profile/09351344829632811877noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-75611691144701472322009-08-23T22:22:59.757-04:002009-08-23T22:22:59.757-04:00Nice catch. Must not have had obvious crepitus or...Nice catch. Must not have had obvious crepitus or skin changes for them not to order a scan...or was it a case of oversight by the ED?Benhttps://www.blogger.com/profile/13219481372640310952noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-49788753932629105272009-08-18T15:46:41.448-04:002009-08-18T15:46:41.448-04:00radinc-
I actually ordered the scan myself. I'...radinc-<br />I actually ordered the scan myself. I've seen a case where a perf sigmoid diverticulitis presented with perineal sepsis. The scan wasn't ordered for diagnostic purposes but rather to plan the inevitable operation. Maybe a waste, but it told me I wouldn't need to do a laparotomy.Jeffrey Parks MD FACShttps://www.blogger.com/profile/15650563299849196122noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-70233046325661687682009-08-18T15:44:25.900-04:002009-08-18T15:44:25.900-04:00Nice Scan. That said anyone who practices medicin...Nice Scan. That said anyone who practices medicine and hasn't been fooled by a NSTI that at first glance looks like a run of the mill cellulitis hasn't been doing it long enough. The key is often the rest of the clinical picture- severe sepsis from a simple cellulitis/abscess is rare and should raise the red flag.Guiacnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-31048797838984940792009-08-16T13:23:56.256-04:002009-08-16T13:23:56.256-04:00aha... so this is why the er scans all their peria...aha... so this is why the er scans all their perianal abscesses. I always wonder why they need me to measure all those 1.5x2.0cm rim enhancing fluid collections. <br /><br />I guess they could rely on the excellent clinical features you described in order to triage their patients... <br /><br />but alas that would require waiting for lab results. faster to send them through the scanner while they prepare the d/c papers.<br /><br />later<br />radincradincnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-1765759039179640252009-08-14T12:07:31.884-04:002009-08-14T12:07:31.884-04:00I agree with the 'impressive scan' comment...I agree with the 'impressive scan' comment. <br /><br />Is the 20k WCC number for all soft tissue infection, or just perianal abscesses? I saw a pretty high WCC with what I thought was simple cellulitis, who I admitted for high dose IVABx, as well as aggressive sugar control. There was no crepitus or rapid spread, just painful red swelling in these huge obese calves that was almost circumferential. I don't think there was much call to be more aggressive.DHShttps://www.blogger.com/profile/00251680600047999918noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-24283484256562774302009-08-14T11:31:36.432-04:002009-08-14T11:31:36.432-04:00Patient doing very well.
Bongi- Young healthy pat...Patient doing very well.<br /><br />Bongi- Young healthy patient, normal WBC, non-toxic. Yeah, if they call me at midnight, I'll drain it at 6:30AM. Same with appendicitis, mostly. Unless I'm dealing with a kid or a very old patient or a septic patient, no difference in outcome if the appy is done right away or within 12 hours. There's plenty of literature to support such practice.Jeffrey Parks MD FACShttps://www.blogger.com/profile/15650563299849196122noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-15865096550660429002009-08-14T11:27:56.314-04:002009-08-14T11:27:56.314-04:00pretty impressive scan.
just interested, you leav...pretty impressive scan.<br /><br />just interested, you leave a perianal abses for the morning? i'd tend to question that.Bongihttps://www.blogger.com/profile/12918640034313468627noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-7480361876718812482009-08-13T15:18:23.544-04:002009-08-13T15:18:23.544-04:00Buckeye, How is she doing, physically as well as m...Buckeye, How is she doing, physically as well as mentally?<br /><br />-SCNSAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-56913942167562009222009-08-13T14:33:39.291-04:002009-08-13T14:33:39.291-04:00Buckeye...I will hold franks head under while you ...Buckeye...I will hold franks head under while you flush :)<br /><br />Ok, so this is one case where having *online medical records doesn't send me over the edge. GREAT CATCH.<br /><br />*(I have done office transcription for 20 years and am losing clients to EMR--it stinks for me personally, but as a patient, it rocks :)OHNhttps://www.blogger.com/profile/03856294075428012923noreply@blogger.comtag:blogger.com,1999:blog-2760353953251845523.post-90575261894144609082009-08-13T12:05:15.709-04:002009-08-13T12:05:15.709-04:00Yeah sure, Buckeye, you just wanted that outrageou...Yeah sure, Buckeye, you just wanted that outrageous Surgeon's fee, sure you didn't take out her appendix or gall bag too?? Couldn't you have tried one of those Blue Pills for a few days? Hows she gonna get Health Insurance now? Run for Congress??<br /><br />BarakAnonymousnoreply@blogger.com