emDOCs.net Emergency Medicine (EM) Podcast Episode 65: NSTI Pearls and Pitfalls Part I
Nov 1, 2022
Jess Pelletier, an EM education fellow and clinical educator, walks through necrotizing soft tissue infections from her case experience. She reviews why NSTIs matter, the spectrum of disease and subtypes, tricky and variable presentations, key risk factors that should raise suspicion, and the limits of lab scores in diagnosis.
AI Snips
Chapters
Transcript
Episode notes
Resuscitation and Advocacy Saved a Misjudged Case
- Jess Pelletier described a 42-year-old man 10 days after I&D for a hematoma who returned with severe pain, fevers, tachycardia, crepitus, and ultrasound showing fascial thickening concerning for NSTI.
- Surgery initially thought cellulitis/hematoma and wanted CT, but Jess insisted and transfer/OR revealed infected hematoma with necrotizing fasciitis, highlighting advocacy for the patient.
Start Broad Antibiotics And Call Surgery Early
- If you suspect NSTI, start broad-spectrum IV antibiotics and resuscitate early while involving surgery immediately.
- Jess gave cefepime, clindamycin, and vancomycin and called surgery to bedside before definitive OR diagnosis.
Necrotizing Infections Form A Microbial Spectrum
- NSTI is a spectrum of diseases; necrotizing fasciitis is only one subtype with types 1–4 having different microbiology and risk profiles.
- Type 1 is polymicrobial in older/immunosuppressed patients; type 2 is monomicrobial (group A strep or MRSA) often after trauma or IV drug use; types 3–4 are rarer (vibrio/clostridium, fungi).