Gas gangrene

Gas gangrene outlined by clostridium difficile caused by an infection of severe acute specificity. According to the different lesions; Bacillus subtilis bacteria infection into muscle necrosis and sexual and Bacillus Cellulites two categories. often said that gas gangrene bacteria Bacillus muscle necrosis mainly occurred in the muscle tissue of patients extensive damage, Minorities in the abdomen or rectum after the operation wound. Clostridium difficile causes of Gram-positive anaerobic bacteria, and gas production by Clostridium perfringens (Ngai bacillus), edema bacillus cereus and corruption as the main, followed by the middle cereus and bacillus dissolved organizations, clinical see gas gangrene. often two or more of the bacteria infection. Clostridium difficile widely found in soil and cow dung, it is easy entry wound, but not necessarily pathogens. Gas gangrene, is not merely to decide on gas gangrene was a presence, More decided to human resistance and the wounds that need to a gas gangrene on Growth and Reproduction of hypoxic environment. Therefore, the water loss, or a large number of hemorrhagic shock, and they have large wound tissue necrosis, deep muscle damage, especially the thigh and buttocks injuries, shrapnel uptime, or open fractures associated with major vascular injuries, tourniquet use such a long time, high gas gangrene. Pathogenesis of gas gangrene bacteria in the wound growth and reproduction, few invasive blood circulation caused septicemia. Gas production capsulectomy bacillus toxin produced Europium, collagenase and hyaluronidase, dissolved fiber enzyme and DNA enzymes, RBC damage caused hemolysis, hemoglobinuria, urinary and kidney necrosis and edema, liquefaction, large muscle necrosis, so that the rapid spread of disease, the deterioration. Carbohydrates have a lot of decomposition gases that enables organizations to expand; Decomposition of protein and gelatin liquefaction, hydrogen, Odor wound occurred. Because ischemia, the plasma leakage, and the role of various toxins, the wounds within the organization and muscle, further necrosis and corruption, more conducive to the breeding of bacteria and disease worsen. A lot of tissue necrosis and exotoxin absorption, can cause severe toxemia. Some toxins can be a direct violation of the heart, liver and kidneys, focal necrosis, which caused organ dysfunction. Diagnosis of early diagnosis and timely treatment is to preserve limb and the key to saving lives. Therefore, to make an early diagnosis. Diagnosis was based on clinical performance, wound exudates examination and X-ray examination, such as after injury or surgery, wound unusual pain, local swelling rapidly intensified, the skin around the wound is filled with pronunciation, and severe systemic poisoning symptoms, such as pulse accelerated, irritability for anemia, that should be given to gas gangrene possible; wound exudates smears of a large number of Gram-positive bacilli. X-ray examination wound muscles between gas, gas gangrene diagnosis of the three important bases. Anaerobic bacterial culture and biopsy confirmed the diagnosis though, but take some time, it can not wait for the results in order not to delay treatment. Clinical manifestations incubation period could be as short as 6-to 8 hours, but generally for a ~ 4 days. Local performance unadvisable patients consciously heavy, bandaging overextended flu. , Suddenly appeared unadvisable "Expansion" for severe pain, can not be used to alleviate the general pain relievers. Unadvisable swelling, tenderness dramatic. The skin around the wound edema, tension, pale and shiny, quickly turned purple and then into purpuric. and the emergence ranging from the size of the blisters. As wound muscle necrosis, or soil conductivity gray and inflexible, not contraction knife or bleeding, as if cooked meat. Wound around often palpable twist to the pronunciation, said a gas organizations exist. Squeeze gently unadvisable, often bubbles escape from the wound, and a thin, obnoxious kind of gutsy serous secretion outflow. Early symptoms of systemic patients dullness, dizziness, headache, nausea, vomiting, cold sweats, irritability, fever, rapid pulse (100 ~ 120 times / min), respiratory Paicu, and for anemia. Advanced symptoms of severe poisoning, blood pressure dropped and last jaundice, delirium and coma. Treatment of gas gangrene developed rapidly, if not handled in a timely manner, patients often losing a limb or even death. Once it was diagnosed, aggressive treatment immediately. 1. Surgical treatment in the emergency rescue serious shock or other serious complications, requiring urgent surgical treatment for localized, Preoperative intravenous infusion of 2 million U penicillin and tetracycline 0.5 g. Generally used general anesthesia, no tourniquet. It should be noted during oxygen to blood transfusion, infusion and antibiotics. In the District for extensive lesions, multiple incision (including wound and the surrounding edema or subcutaneous emphysema), Resection of no longer living tissue, until with normal color, flexibility and new blood outflow can muscle up. Open wound with a large number of 3% hydrogen peroxide solution or a : 4000 potassium permanganate solution to wash. Postoperative wounds remain open, hydrogen peroxide solution used wet dressing, dressing several times daily replacement. Any of the following should be considered amputation : a, limb floors organizations have involved rapid development; B, serious physical injury, Merger open comminuted fracture or with vascular injury; c, debridement is still dealing with infection control, there were serious toxemia. Amputations were not to be involved in the muscle of the Department of Health. Amputation stump is not repaired, hydrogen peroxide solution used wet dressing until the wound healed after dressing. 2. Hyperbaric oxygen therapy in the three pure oxygen under atmospheric pressure to the physical state dissolved oxygen in the blood than usual increase 20 times, organizations can improve the oxygen content, gas gangrene inhibit the growth of bacilli, and have it stop Europium toxins, generally within three days of the 7th treatment, a meeting / 2 hours, 6 ~ 8 hours interval. Which for the first three days, the second and third day of the 2nd, in a meeting after treatment to check the wound and will have necrosis of tissue resected, But not for the extensive debridement, or removal to health organizations. Thereafter, the condition of patients can be repeated debridement. Through this method of treatment, the number of limb function can be preserved. Also observed that all can be completed within the first 48 h 5th hyperbaric oxygen therapy of the patients, almost all survive. However, the need for high-pressure oxygen equipment under difficult field conditions applied. 3. The use of high-dose antibiotics penicillin (10 million U / d) and tetracycline (2 g / d), and control purulent infection, reduce gr oup other bacteria breeding oxygen consumption caused by hypoxia environment. Susceptibility to localized symptoms and the situation improved, the dose can be reduced or suspended. Allergic to penicillin, erythromycin can be used, the 1.5-1.8g / d, an intravenous drip. 4. Systemic therapy support small number of blood transfusion to correct water and electrolyte metabolism disorders, given high-protein, high-calorie diet. pain, sedation, such as cooling. Gas gangrene of antivenins gas gangrene had poor play only temporarily alleviate the role of toxemia, but also to enable the patient to the risk of allergic reactions occur, is rarely applied.