Gas Gangrene

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Gas Gangrene

• A Presentation by Jennifer Kent-Baker

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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.

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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.

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Risk Factors

• Trauma or recent surgical wound
• Arthrosclerosis
• Diabetes
• Colon Cancer

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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.

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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

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Signs and Symptoms, cont.

• Blisters filled with brown-red fluid
• Drainage from the tissues, foul-smelling
  serosanguineous discharge
• Tachycardia
• Diaphoresis
• Subcutaneous emphysema

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Gas Gangrene Illustrated
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Diagnostics

• Gram stain of fluid from the infected area
• Culture
• Blood cultures
• Anaerobic tissue and/or fluid culture
• MRI

Cat Scan
X-Ray
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Medical Management

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

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Nursing Interventions

• Wound care with strict medical asepsis
• Autoclaving of equipment and linens
• Drainage and secretion isolation

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Medications

• Antibiotics
• Analgesics
• Hyperbaric oxygen

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Complications

• Disfiguring or disabling permanent tissue damage
• Jaundice with liver damage
• Kidney failure
• Sepsis
• Shock
• Stupor
• Delirium
• Coma
• Death (That is a complication, isnt it?)

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Prognosis

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