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A 16-year-old male presents to the emergency department one day after scratching his leg on a piece of scrap metal. He reports a progressive rash on his leg that has advanced over the last several hours. In the emergency room his temperature is 102.8 degrees and his systolic blood pressure is 98 mmHg. On physical exam the clinical finding shown in Figure A is found. What would be the most appropriate next step in treatment.
Biopsy with urgent frozen section in the operating room
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Poor outcomes with necrotizing fasciitis have been associated with which of the following factors?
Pre-existing cardiac dysfunction
Use of hyperbaric oxygen
Intravenous drug abuse
Delay in time to diagnosis
A 52-year-old diabetic male sustained minor blunt trauma to his left thigh 10 hours prior to presentation. He initially complained of extreme thigh pain with erythema and swelling but rapidly developed bullae and worsening erythema over the affected area along with fever and tachycardia. A clinical photo is shown in Figure A. What clinical factor has been shown to reduce mortality when treating this pathology?
Presence of MRI findings
Administration of pressors
Decreasing time from admission to surgery
Immediate identification of causative organism
Location of injury
A 56-year-old diabetic male presents to the emergency department by ambulance after developing high-grade fevers, malaise, and altered mental status. Upon presentation, he is found to be hypotensive and initial labs show an elevated WBC with a profound left shift. Figure A shows skin manifestations confined to the foot at initial presentation. He is started on broad spectrum antibiotics. Upon follow-up exam 3 hours later his clinical condition deteriorates (Figure B) and he is taken to the operating room for surgical debridement. In a bacterial culture, what would be the most common single isolate for this condition?
Group A streptococcus
Necrotizing fasciitis treatment