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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
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>.