A 60-year-old male with a past medical history notable for obesity, hypertension, hyperlipidemia, and type 2 diabetes presents to the emergency department with complaints of significant scrotal and perineal pain with associated drainage. He explains that the symptoms started about 24 hours before presentation and have been rapidly progressive since. His vital signs are as follows: Temp 102.5°F, HR 102 bpm, BP 90/65 mm Hg, RR 18, Sat 100% on room air. On examination, he is diaphoretic and noticeably uncomfortable. His scrotum and perineum are diffusely erythematous and tender to palpation, with a pinpoint area draining dishwasher color fluid that is malodorous. All of the following are appropriate next steps in the management of a patient presenting with Fournier’s gangrene EXCEPT:
A. Aggressive fluid resuscitation to markers of end organ perfusion as dictated by early goal-directed therapy Wrong Choice!
B. After acquiring appropriate culture data, initiation of broad spectrum antimicrobial therapy with empiric coverage for NSTI causing organisms Wrong Choice!
C. Obtaining radiographic imaging to delineate the extent of infection and to aid in operative planning D. Early surgical consultation for urgent evaluation and operative debridement Correct Choice
D. Postoperative admission to a surgical intensive care unit for ongoing monitoring and hemodynamic support Wrong Choice!
Answer:C
A 60-year-old male with a past medical history notable for obesity, hypertension, hyperlipidemia, and type 2 diabetes presents to the emergency department with complaints of significant scrotal and perineal pain with associated drainage. He explains that the symptoms started about 24 hours before presentation and have been rapidly progressive since. His vital signs are as follows: Temp 102.5°F, HR 102 bpm, BP 90/65 mm Hg, RR 18, Sat 100% on room air. On examination, he is diaphoretic and noticeably uncomfortable. His scrotum and perineum are diffusely erythematous and tender to palpation, with a pinpoint area draining dishwasher color fluid that is malodorous. All of the following are appropriate next steps in the management of a patient presenting with Fournier’s gangrene EXCEPT:
A. Aggressive fluid resuscitation to markers of end organ perfusion as dictated by early goal-directed therapy Wrong Choice! B. After acquiring appropriate culture data, initiation of broad spectrum antimicrobial therapy with empiric coverage for NSTI causing organisms Wrong Choice! C. Obtaining radiographic imaging to delineate the extent of infection and to aid in operative planning D. Early surgical consultation for urgent evaluation and operative debridement Correct Choice D. Postoperative admission to a surgical intensive care unit for ongoing monitoring and hemodynamic support Wrong Choice!