Gas gangrene 8 - 2- 16

A ppt on gas gangrene

1. GAS GANGRENE DR.R.DURAI MS ASSISTANT PROFESSOR DEPT. OF GENERAL SURGERY MGMCRI

2. What is a Gangrene? localized cell death by obstructed circulation with superadded bacterial infection. 2 08-02-2016 GAS GANGRENE BY DR.R.DURAI MGMCRI

3. What is a Gas Gangrene? Gangrene produced gas producing organisms like Clostridium perfringens ( welchii ) Oedematous myonecrosis – Skeletal muscle Malignant edema 3 08-02-2016 GAS GANGRENE BY DR.R.DURAI MGMCRI

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5. Source of Infection Contaminated, manured or cultivated soil, intestines F aecal flora Crush wounds War wounds Anaerobic environment 5 08-02-2016 GAS GANGRENE BY DR.R.DURAI MGMCRI

6. Organisms Clostridium welchii ( perfringens ): Gram-positive, central spore bearing, nonmotile , capsulated organisms Clostridium oedematiens . Clostridium septicum . Clostridium histolyticum . 6 08-02-2016 GAS GANGRENE BY DR.R.DURAI MGMCRI

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8. TOXINS Alpha (most common) Beta Epsilon Iota Phi toxin—myocardial depressant Kappa toxin—destruction of connective tissue and blood vessels Bursting factor and circulating factor 8 08-02-2016 GAS GANGRENE BY DR.R.DURAI MGMCRI

9. EXOTOXINS Lecithinase Haemolysin Hyaluronidase Proteinase 9 08-02-2016 GAS GANGRENE BY DR.R.DURAI MGMCRI

10. EFFECTS Anaerobic myositis/ myonecrosis . – Hydrogen Sulphide gas –black/ brown muscle Extensive spread – thoracic & abdominal wall Foaming Liver 10 08-02-2016 GAS GANGRENE BY DR.R.DURAI MGMCRI

11. Clinical Features Incubation period is 1-2 days Toxaemia Fever Tachycardia Pallor 11 GAS GANGRENE BY DR.R.DURAI MGMCRI 08-02-2016

12. Contd … Wound is under tension with foul smelling discharge (sickly sweety /decaying apple odour). Khaki brown coloured skin Crepitus Jaundice ,oliguria Frequent sites are adductor region of the lower limb and buttocks and subscapular region in upper limb. 12 08-02-2016 GAS GANGRENE BY DR.R.DURAI MGMCRI

13. Clinical Types Fulminant type Massive type Group type Single muscle type Subcutaneous type 13 08-02-2016 GAS GANGRENE BY DR.R.DURAI MGMCRI

14. Investigations X-ray LFT ,RFT, ABG CT Gram Stain Robertson’s Cooked meat media – meat to turn pink with sour smell and acid reaction . Nagler reaction. 14 08-02-2016 GAS GANGRENE BY DR.R.DURAI MGMCRI

15. Complications Septicaemia, toxaemia. Renal failure, liver failure. Circulatory failure, DIC, secondary infection. Death occurs in critically ill patients. 15 08-02-2016 GAS GANGRENE BY DR.R.DURAI MGMCRI

16. Treatment Injection benzyl penicillin 20 lacs 4th hourly + Injection metronidazole 500 mg 8th hourly + Injection aminoglycosides (if blood urea is normal) or third generation cephalosporins or metronidazole. Fresh blood transfusion Polyvalent antiserum 25,000 units given intrav enously after a test dose and repeated after 6 hours Hyperbaric oxygen 16 08-02-2016 GAS GANGRENE BY DR.R.DURAI MGMCRI

17. Contd … Radical Wound Debridement Rehydration Amputation V entilator support Fumigation of theatre after treatment 17 08-02-2016 GAS GANGRENE BY DR.R.DURAI MGMCRI

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