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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

GaNGRENE

By ShawnLahodny


Objectives

Objectives

  • Learn what gangrene is

  • What causes gangrene

  • Who is at risk

  • The different types

  • Complications and how we treat

  • Prevention


What is gangrene

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.


Causes

Causes

  • Lack of blood flow to a region of the body.

    • Thrombosis

    • Peripheral vascular disease

      • Atherosclerosis

    • Diabetes

      • Causing damaged blood vessels


Causes cont

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


  • Who is at risk

    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


    Types of gangrene

    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.


    Dry gangrene cont

    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)


    Types of gangrene cont

    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.


    Wet gangrene cont

    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.


    Types of gangrene cont1

    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


    Gas gangrene cont

    Gas Gangrene cont..

    • Where and how can bacteria be obtained?

      • Most likely found in soil

      • Enters through an open wound


    Gas gangrene cont1

    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


    Types of gangrene cont2

    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


    Possible complications

    Possible Complications

    • Tissue necrosis

    • Loss of a limb

    • Sepsis

    • Death


    What will we see

    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


    How would you treat in 1100ad

    How would you treat in 1100ad

    • Maggot therapy

      • Maggots eat the dead flesh

    • Antibiotics soon became the treatment


    Pre hospital treatment

    Pre Hospital Treatment

    • Treat for Septic Shock

      • Oxygen

      • IV fluids

      • Consider dopamine to correct hypotension

    • Consider pain meds


    Signs of septic shock review

    Signs of Septic Shock review

    • Fever or low temp (hypothermic)

    • Increased cardiac output

    • Low BP

    • Shortness of breath

    • Possible altered mental status


    Hospital treatment

    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)


    Hospital treat ment cont

    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


    Prevention

    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


    Questions

    Questions?


    Bibliography

    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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