Question

A 35-year-old man is admitted to the hospital with fever, altered mental status, and swelling with redness on his abdomen of 6 days' duration. He has a history of poorly controlled diabetes and chronic renal insufficiency. On examination, he is lethargic. His vital signs are as follows: heart rate, 89 beats/min; blood pressure, 80/40 mm Hg; respiratory rate, 33 breaths/min; oxygen saturation as measured by pulse oximetry, 92%; and temperature, 39 °C (102.2 °F). His abdomen has erythema, and air is felt by palpation of the soft tissue. When palpated, he yells out in extreme pain (10/10). His laboratory test results include: WBC count, 33,000/µL with 18% bands; hemoglobin, 12.5 g/dL; glucose, 320 mg/dL; sodium, 145 mEq/L; potassium, 4 mEq/L; creatinine, 3.5 mg/dL (baseline 2.2 mg/dL); and lactate, 6.5 mEq/L. IV fluids are started for aggressive resuscitation. He is started on high-flow oxygen and blood cultures are obtained. Which of the following is the most appropriate strategy in this patient's management?

Answer 1

Immediate surgical consultation and intervention should be initiated to manage this patient suspected to have necrotizing fasciitis.

Step-by-step explanation:

The most appropriate strategy in this patient's management would be to suspect the presence of necrotizing fasciitis and initiate immediate surgical consultation for intervention.

Necrotizing fasciitis is a rapidly progressing soft tissue infection that can lead to sepsis and organ failure. The patient's clinical presentation, including fever, altered mental status, and a swollen, erythematous abdomen, along with laboratory findings of leukocytosis, elevated lactate, and renal insufficiency, are consistent with this diagnosis. Prompt administration of IV fluids and antibiotics along with aggressive surgical debridement is the mainstay of treatment to control the infection and prevent further tissue necrosis.

It is important to note that necrotizing fasciitis is a medical emergency that requires immediate intervention to improve the patient's outcome.