Gas Gangrene in Emergency Medicine Treatment & Management

  • Author: Anil Shukla, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Jun 22, 2009
 

Prehospital Care

Prehospital care for gas gangrene includes the following:

  • Oxygenation
  • Intravenous (IV) fluids
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Emergency Department Care

Gas gangrene is a true emergency, and concurrent evaluation, treatment, and coordination of care should be carried out.[1, 2, 3]

Generally speaking, the treatment is a combination of antibiotics, surgery, and hyperbaric oxygen.

  • Airway and breathing: Oxygen and airway management as necessitated by the clinical picture.
  • Circulation: Good vascular access and liberal use of intravenous fluids is indicated. Frequent reassessment of the circulatory status is necessary. If pressors are necessitated, vasoconstrictors should only be used if absolutely necessary; they can decrease perfusion to already ischemic tissue.
  • Administer tetanus toxoid if indicated.
  • Administer antibiotics.
  • Correct electrolyte abnormalities.
  • Check compartment pressures if severe pain and evidence of compartment syndrome are present with minimal cutaneous evidence of infection.
  • Wound care is indicated.
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Consultations

Obtain immediate surgical consultation. Definitive treatment of gas gangrene is wide debridement of necrotic muscle. This is identifiable because it does not bleed or contract when debrided. While laboratory studies and imaging studies may help make the diagnosis of gas gangrene, the criterion standard is tissue biopsy.

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Contributor Information and Disclosures
Author

Anil Shukla, MD  Staff Physician, Harvard Affiliated Emergency Medicine Residency, Beth Israel Deaconess Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Carlo L Rosen, MD  Associate Professor of Medicine, Harvard Medical School; Program Director, Vice Chair for Education, Department of Emergency Medicine, Beth Israel Deaconess Medical Center/Harvard Affiliated Emergency Medicine Residency program

Carlo L Rosen, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Jason K Wong, MD  Staff Physician, Department of Emergency Medicine, Jefferson Regional Medical Center

Jason K Wong, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Michelle Ervin, MD  Chair, Department of Emergency Medicine, Howard University Hospital

Michelle Ervin, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, National Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Barry J Sheridan, DO  Chief, Department of Emergency Medical Services, Brooke Army Medical Center

Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

  1. Trott AT. Skin and Soft-tissue Infections. In: Wolfson AB, et al, eds. Harwood-Nuss' Clinical Practice of Emergency Medicine. 4th ed. Lippincott Williams & Wilkins; 2005:715-717.

  2. Folstad SG. Soft tissue infections. In: Tintinalli JE, et al, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. McGraw Hill; 2004:979-986.

  3. Meislin HW, Guisto JA. Soft tissue infections. In: Marx JA, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 5th ed. Mosby-Year Book; 2002:1944-1955.

  4. Stevens DL. The pathogenesis of clostridial myonecrosis. Int J Med Microbiol. Oct 2000;290(4-5):497-502. [Medline].

  5. Brook I. Recovery of anaerobic bacteria from wounds after lawn-mower injuries. Pediatr Emerg Care. Feb 2005;21(2):109-10. [Medline].

  6. Headley AJ. Necrotizing soft tissue infections: a primary care review. Am Fam Physician. Jul 15 2003;68(2):323-8. [Medline].

  7. Bryant AE. Biology and pathogenesis of thrombosis and procoagulant activity in invasive infections caused by group A streptococci and Clostridium perfringens. Clin Microbiol Rev. Jul 2003;16(3):451-62. [Medline].

  8. Miller LG, Perdreau-Remington F, Rieg G, et al. Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med. Apr 7 2005;352(14):1445-53. [Medline].

  9. Fridkin SK, Hageman JC, Morrison M, et al. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med. Apr 7 2005;352(14):1436-44. [Medline].

  10. Anesti E, Brooks P, Majumder S. Images in emergency medicine. Gas gangrene. Ann Emerg Med. Jul 2007;50(1):14, 33. [Medline].

  11. Arteta-Bulos R, Karim SM. Images in clinical medicine. Nontraumatic Clostridium septicum myonecrosis. N Engl J Med. Oct 21 2004;351(17):e15. [Medline].

  12. Frazee BW, Lynn J, Charlebois ED, Lambert L, Lowery D, Perdreau-Remington F. High prevalence of methicillin-resistant Staphylococcus aureus in emergency department skin and soft tissue infections. Ann Emerg Med. Mar 2005;45(3):311-20. [Medline].

  13. Schneider DJ, Reid JS. Images in clinical medicine. Gas gangrene associated with occult cancer. N Engl J Med. Nov 30 2000;343(22):1615. [Medline].

  14. Swartz MN. Clinical practice. Cellulitis. N Engl J Med. Feb 26 2004;350(9):904-12. [Medline].

  15. Wang C, Schwaitzberg S, Berliner E, Zarin DA, Lau J. Hyperbaric oxygen for treating wounds: a systematic review of the literature. Arch Surg. Mar 2003;138(3):272-9; discussion 280. [Medline].

  16. Smith-Slatas CL, Bourque M, Salazar JC. Clostridium septicum infections in children: a case report and review of the literature. Pediatrics. Apr 2006;117(4):e796-805. [Medline].

  17. Temple AM, Thomas NJ. Gas gangrene secondary to Clostridium perfringens in pediatric oncology patients. Pediatr Emerg Care. Jul 2004;20(7):457-9. [Medline].

 
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A patient developed gas gangrene after injecting cocaine. Clostridium septicum was isolated in both blood and wound cultures.
Left lower extremity in a 56-year-old patient with alcoholism who was found comatose after binge drinking. Surgical drainage was performed to treat the pyomyositis-related, large, non–foul-smelling (sweetish) bullae. Gram staining showed the presence of gram-positive rods. Cultures revealed Clostridium perfringens. The diagnosis was clostridial myonecrosis.
 
 
 
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