Gas gangrene by Dr.AmrithaAnilkumar

Gas gangrene is an infective gangrene caused by clostridial organisms involving mainly skeletal muscle as oedematous myonecrosis.

1. e n love da Homoeopathy GAS GANGRENE

2. GAS GANGRENE

3. GAS GANRENE Definition It is an infective gangrene caused by clostridial organisms involving mainly skeletal muscle as oedematous myonecrosis .

4. PREDISPOSING FACTORS Contaminated, manured or cultivated soil crush wounds road traffic accidents after amputations ischaemic limb necrosis Anaerobic environments clostridial sepsis

5. ORGANISMS Clostridium Welchii (perfringens) Clostridium oedematiens . Clostridium septicum . Clostridium histolyticum ORGANISM PRODUCING TOXINS™ Alpha (most common) ™ Beta ™ Epsilon ™ Exotoxins Lecithinase - haemolytic, membranolytic and necrotic

6. EFFECTS OF TOXINS Extensive necrosis brown or black anaerobic myositis/ myonecrosis . affects the liver— foaming liver Limbs are commonly involved INCUBATION PERIOD Incubation period is 1–2 days. CLINICAL FEATURES Toxaemia, Fever Tachycardia Pallor Foul smelling discharge (sickly sweaty/decaying apple odour). Khaki brown coloured skin Crepitus Jaundice

7. CLINICAL TYPES Fulminant type - causes toxaemia, renal failure Liver failure MODS ARDS. Massive type fully dark coloured gas filled areas. Group type Infection of one group of muscles Single muscle type affecting one single muscle. Subcutaneous type involves only subcutaneous tissue COMPLICATION™ Septicaemia Toxaemia Renal failure Liver failure. Circulatory failure DIC

8. INVESTIGATIONS X-ray Liver function tests Blood urea Serum creatinine Total count, PO2, PCO2. Robertson’s cooked meat media is used which causes meat to turn pink with sour smell and acid reaction Clostridium Welchii is grown in culture media & In the other half part of the plate where there is antitoxin there is no opacity— Nagler reaction.

9. TREATMENT Antibiotic & Hyperbaric oxygen is very useful. A mputation life-saving procedure—stump should never be closed REFERENCE SRB's Manual of Surgery by Sriram Bhat M 2. A Manual on Clinical Surgery by Das 3. A C oncise textbook of Surgery by Das

10. A Special Thanks To A Very Special Doctor