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Clostridial myonecrosis

  • Kathleen A Cline
    Affiliations
    University of Illinois Affiliated Hospitals Emergency Medicine Residency, Chicago, Illinois, USA
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  • Timothy L Turnbull
    Correspondence
    Address for reprints: Timothy L Turnbull, MD, Department of Emergency Medicine, Mercy Hospital and Medical Center, Stevenson Expressway at King Drive, Chicago, Illinois 60616.
    Affiliations
    University of Illinois Affiliated Hospitals Emergency Medicine Residency, Chicago, Illinois, USA
    Search for articles by this author
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      Summary

      Clostridial infections, particularly myonecrosis, can be fulminant and fatal; they often arise without an obvious history of trauma. The cardinal diagnostic clues (Figure 3) must be recognized so that specific therapy can be initiated promptly and mortality can be minimized. Aggressive medical care, including crystalloid fluid therapy and antibiotics, must be initiated quickly. Vasopressors should be avoided. Antitoxin has no role in contemporary care. Early hyperbaric oxygenation is beneficial, but it should be preceded by decompressive fasciotomy if limb edema is marked. Otherwise, definitive debridement or amputation is best delayed until after hyperbaric therapy is begun. Regionalization of care and long transport times also must be considered seriously in determining the therapeutic approach.
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