Necrotizing Fasciitis - JLampert

Necrotizing Fasciitis - JLampert - QuickTime and a TIFF(LZW...

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Necrotizing Fasciitis The Mount Sinai Department of Surgery Surgery IV Conference Joshua A Lampert, M.D. March 28, 2006 QuickTimeª and a TIF (LZW) decompres or are ne ded to se this picture.
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VH CC : ER on 3/18/2006 with Abdominal Pain 43 y/o M Hx Sarcoid (2/2003) off steroids since 1/2004 recently for elective repair of left inguinal hernia on 3/8/2006 after 6 months of increasing symptoms, bulging, and pain last month. Presented to ER with severe abdominal pain though did well initially postop, NL Bowel function, Flatus, BM POD #2, decreased pain, ambulation. POD #6 increased pain left abd, flank, and scrotum Rad to anterior Abd worse standing. Anorexia. Constipation. POD #8 + N/V Bilious. POD #9 Insomnia, Night sweats & Chills, tactile fever. Less pain at incision, severe upper abdomen and chest. POD #10 wife insisted on ER.
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VH PMedHx : Sarcoid (off steroids) PUD (H. pylori 1997) Chronic back pain (MRI: mild disc protrusion C4-6) OA PSurgHx : Left ACL 3/2003 Direct LIH Repair 3/8/2006 (plug/patch. Kefzol) FHx: Mother DM II SocHx: Negative x 3 Building Maintenance Sexually inactive currently (in therapy) Allergy: Shellfish Meds: Pulmacort, Celebrex, Alleve (Prednisone 40 QD wean off since 1/2004)
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VH 3/18/06 Phys Exam: A & O X 3. Pain 10/10. Tmax 40.3, BP: 105/79, P: 130-159, RR 18, 100% RA HEENT: Perla, EOMi. PULM: CTA B/L CVA: S1S2 Tachy. ABD: Distended, Diffuse (LUQ>LLQ), severe tender with min. palp and movement. Pos. Guard & Rebound. Incision C/D/I (epithelialized with NO erythema, skin changes, nor fluctuance). No Hernias. Sm. Sub Q emphysema LUQ under rib cage. Rectal: Heme neg. NL tone & brown stool.
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VH LABS WBC 19.9 (60% N ), HCT 42.9, Plt 325 Na 132, K 4.0, Cl 93, CO2 20, BUN 22, Cr 1.6 , Glucose 133 PTT 36, INR 1.3 ABG: 7.41/29/82/18/97.6 Lactate: 2.0 Port CXR: b/l hilar LAD, No Free air, no change
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VH: Cat Scan
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VH Cat Scan
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VH Cat Scan
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VH: Pink Slip CT: Large air, fluid, debris collection (26x14x3.4 cm) left lateral anterior Abd Wall from Left inguinal region to left ext iliacs up to left level of the ribs. Dilated SB c/w ileus Received in ED: Hi dose PCN, Flagyl 500mg, Rocefin 1Gm. Analgesia. IVF’s Consent obtained, Category 1 Pink Slip In Holding: Clinda 300 mg, Ampicillin 2 G, ID consult started Zosyn.
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VH Diag Lap: Small segment of sig colon adherent to left inguinal hernia repair area with only local inflam. No pus nor frank SN’s of infection intra-abdom. Prev hernia incis open foul smelling pus. Necrotic fascia sent specimen w/Cx. Incis extended 25 cm lat up to rib cage. Mesh removed Necrotic subcut and fascia debride to viable To SICU post op.
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VH POD #1: T 39.4 > 36.5 Tachy 101. 110/60. Good u/o. Extub. WBC 11.4 Dressing change min. fibrinous exudate, viable
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Necrotizing Fasciitis - JLampert - QuickTime and a TIFF(LZW...

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