Gas Gangrene A Presentation by Jennifer Kent-Baker

What is Gangrene? Gangrene is necrosis and subsequent decay of body tissues caused by infection or thrombosis or lack of blood flow. It is usually the result of critically insufficient blood supply sometimes caused by injury and subsequent contamination with bacteria. This condition is most common in the extremities. The best of all possible treatments is revascularization of the affected organ, which can reverse some of the effects of necrosis and allow healing.

What is Gas Gangrene? Gas gangrene is a severe form of gangrene usually caused by Clostridium perfringens. It can also be from Group A Streptococcus. Staphylococcus aureus and Vibrio vulnificus can cause similar infections.

Risk Factors Trauma or recent surgical wound Arthrosclerosis Diabetes Colon Cancer

Onset The onset of gas gangrene is sudden and dramatic. Inflammation begins at the site of infection as a pale-to- brownish-red and extremely painful tissue swelling. Gas may be felt in the tissue as a crackly sensation when the swollen area is pressed with the fingers. The edges of the infected area expand so rapidly that changes are visible over a few minutes. The involved tissue is completely destroyed. Clostridium bacteria produce many different toxins, four of which can cause potentially fatal syndromes. In addition, they cause necrosis, hemolysis, vasoconstriction, and increased vascular permeability.

Signs and Symptoms Symptoms usually begin suddenly and rapidly worsen. Moderate to severe pain around a skin injury Progressive swelling around a skin injury Moderate to high fever Initial pallor, later dusky progressing to dark red or purple Vesicle formation

Signs and Symptoms, cont. Blisters filled with brown-red fluid Drainage from the tissues, foul-smelling serosanguineous discharge Tachycardia Diaphoresis Subcutaneous emphysema

Gas Gangrene Illustrated

Diagnostics “Cat” Scan X-Ray   Gram stain of fluid from the infected area   Culture   Blood cultures   Anaerobic tissue and/or fluid culture   MRI

Medical Management Establish a larger wound opening to admit air and promote drainage Antibiotics via IV Wound debridement Amputation

Nursing Interventions   Wound care with strict medical asepsis   Autoclaving of equipment and linens   Drainage and secretion isolation

Medications   Antibiotics   Analgesics   Hyperbaric oxygen

Complications Disfiguring or disabling permanent tissue damage Jaundice with liver damage Kidney failure Sepsis Shock Stupor Delirium Coma Death (That is a complication, isn’t it?)

Prognosis Gas gangrene is progressive and often lethal. Immediate medical attention is required.