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GaNGRENE

GaNGRENE. By Shawn Lahodny. Objectives. Learn what gangrene is What causes gangrene Who is at risk The different types Complications and how we treat Prevention. What is Gangrene?.

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GaNGRENE

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  1. GaNGRENE By ShawnLahodny

  2. Objectives • Learn what gangrene is • What causes gangrene • Who is at risk • The different types • Complications and how we treat • Prevention

  3. What is Gangrene? • Gangrene is characterized by tissue necrosis (cell death), caused by either infection or ischemia to a certain region of the body. Most commonly the extremities, but could even be the organs.

  4. Causes • Lack of blood flow to a region of the body. • Thrombosis • Peripheral vascular disease • Atherosclerosis • Diabetes • Causing damaged blood vessels

  5. Causes cont.. • Severe injury- swelling • Any immune disorder that reduces the bodies ability to fight infection. (HIV) • Frostbite • Frostbite impairs circulation in the affected region • Infection

  6. Who is at risk? • Elderly • Immune defficiency • Atherosclerosis • Diabetics • Damaged blood vessels causing poor perfusion • Persistant tobacco users causing blood vessel damage. • Immunosuppresed • Recent surgery

  7. Types of Gangrene • Dry Gangrene- • Most commonly caused by an interruption of blood flow for a prolonged period of time. • Commonly starts in the distal ends of the limbs(toes and fingers) • People with impaired blood flow to the extremities such as diabetics are at greater risk of getting it. • Characterized by dry shriveled skin with brown, purplish blue or black color. • Black coloration is a product of pooled blood.

  8. Dry Gangrene cont.. • Early signs of this form include- • A dull ache and cool sensation at the affected area • Pallor of the flesh (pale skin)

  9. Types of Gangrene cont.. • Wet Gangrene- • Usually starts in moist areas of the body such as thelungs, bowel, cervix or mouth, but can also be found in other places as well. • What is it? • The tissue is infected by a saprogenic microorganism causing swelling of the tissue. • Usually rapid onset due to blockage of venous and or arterial blood.

  10. Wet Gangrene cont.. • Affected region becomes saturated with stagnant blood promoting rapid growth of bacteria. • Bacteria produces toxic products that can cause one to become septic.

  11. Types of Gangrene cont.. • Gas Gangrene- • Very deadly form of Gangrene • Usually caused by Clostridium perfringens bacteria. • Infection spreads quickly due to the gas production by the bacteria, rapidly contaminating tissue nearby • Rapidly spreads through the body • Toxins will cause tissue death and sepsis very quickly

  12. Gas Gangrene cont.. • Where and how can bacteria be obtained? • Most likely found in soil • Enters through an open wound

  13. Gas Gangrene cont.. • Appearance- • Pale skin evolving to purplish-red or grey in color • Skin may have crackling sound when pressed on similar to subcutaneous emphysema

  14. Types of Gangrene cont.. • Internal Gangrene- • Hernias left untreated causing poor perfusion of the affected tissue. • Can lead to death • Signs • Fever and sever pain • Sepsis

  15. Possible Complications • Tissue necrosis • Loss of a limb • Sepsis • Death

  16. What will we see? • Pt complaining of severe pain • Upon assessment you may find discoloration • Pain may appear to be more drastic than what you see in the affected region

  17. How would you treat in 1100ad • Maggot therapy • Maggots eat the dead flesh • Antibiotics soon became the treatment

  18. Pre Hospital Treatment • Treat for Septic Shock • Oxygen • IV fluids • Consider dopamine to correct hypotension • Consider pain meds

  19. Signs of Septic Shock review • Fever or low temp (hypothermic) • Increased cardiac output • Low BP • Shortness of breath • Possible altered mental status

  20. Hospital Treatment • Surgical intervention to renew blood flow sometimes used to treat dry gangrene • Antibiotics for all types • Operation to remove affected tissue (common with wet gangrene)

  21. Hospital Treatment cont.. • Complete amputation • Hyperbaric oxygen therapy • Forcing oxygen rich blood into the dying tissue • Kills off the bacteria that thrive only in an oxygen free area. • Used to treat early stage gas gangrene

  22. Prevention • Keep open wounds clean • Especially diabetics and people who areimmunosuppressed • Watch for infection • Diabetics should control their blood sugar • High blood sugar over time damages blood vessels and reduces perfusion • If frostbite occurs seek medical attention

  23. Questions?

  24. Bibliography • Bledsoe, Bryan E., Robert S. Porter, and Richard A. Cherry. Paramedic Care. Second ed. Vol. 1. Upper Saddle River: Pearson Education, 2006. 217-219. • "Gangrene." Mayo Clinic. 10 Aug. 2007. 23 May 2008 <www.mayoclinic.com>. • "Gangrene." Wikipedia. 25 May 2008. 25 May 2008 <www.wikipedia.org>. • Greenfield, Ronald A. "Gangrene." EMedicineHealth. University of Oklahoma School of Medicine. 25 May 2008 <http://www.emedicinehealth.com/gangrene/page9_em.htm>.

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