Fasciitis necrotisant e ñawu nguu ina yaawi saabaade Banngeeji boɗeeji¶

Fasiitis nekrotisant (ko ɓuri heewde wiyeede ko "rafi ñaamoowo kosam") e Infections tissue soft nekrotisants (NSTIs) goɗɗi, ina heen Gangrene Fournier e nder reedu/perineum e **mionekrosis klostridiyel (gangrene gaz sur-infecte et mo) emergency e nder safaara. Ina wayi no cellulitis gaadoraaɗo (mo ɓuuɓnata tan ko laabi ɓalndu dowri, ina jaaboo no moƴƴi e antibiotik tan), fasciitis nekrotik ina doga e dow planeeji fascial luggiɗɗi, ɗi ngalaa ƴiiƴam no feewi, les ɓalndu e fat e njaaweeki haa 2s (ho 3 centimeter,100)yaltinde tooke bakteriiji ɓuuɓnooje ƴiiƴam, ɓuuɓnooje ƴiiƴam, kadi ina addana Syndrome de choc toxique** bonɗo e ŋakkeende terɗe keewɗe e nder waktuuji 12 haa 36. Sabu ƴiiƴam ɓuuɓɗam ina haɗa antibiyotikaaji gonɗi e nder ƴiiƴam ɗiieeɗde yettaade fascia luggiɗka maayɗo oo, safaara gooto tan mo hisnata nguurndam e tergal ko debridement surgical (taƴgol denndaangal ƴiiƴam ɗam) e nder waktuuji seeɗa caggal nde o ari e safrirde, tawa ina yahdi e antibiyotikaaji gonɗi e nder ƴiiƴam ɗii, ɗi mbaydi mum en yaajndi e antibiyotikuuji gonɗi e nder ƴiiƴam ɗii.

Waɗde ɗum jooni¶

1. Ƴeewto ɗoon e ɗoon ngam yiytude 6 Banngeeji boɗeeji Fasciitis Nekrotisant ("NAAƊE, PURPLE, POPPING, PACE, PERINEUM, PULSE"). Noddu limoore emergency nokku maa walla yah to mawɗo **Departemaa emergency opitaal mo 24/7 General/Trauma askin Surgery of the:
2. Nafoore nde alaa ɗo haaɗi (walla ɓuuɓnde no feewi): Nafoore 10-e-10 luggiɗnde walla ɓuuɓnde nanndunde e ko ɓuri tiiɗde e ɓuuɓri tokosiri walla ɓuuɓri pinndi, WALLA **nafoore yaajnde 3 haa 5 santimeeteeruuji (1.2 haa 2 inch) e nokku boɗeejo ko ɗoon e ɗoon yahata maayɗo-numb (anesthésie cutanée) sabu neruuji luggiɗɗi ɗii maayii.
3. Bulɗe PURPLE / Dusky Skin walla Bullae (Blisters): Kala mbaydi ɓuuɓri-boɗeeri, njamndi mboɗeeri, walla ɓaleeri-boɗeeri (ecchymosis), walla ɓuuɓri keewndi ndiyam (bullae hemorragique) keewndi ndiyam "ndiyam ndiyam" boɗejam-boɗejam ɓalejam.
4. POPPING / Ɓoornugol les ɓalndu (Subcutaneous Crepitus): Ɓoornugol, ɓuuɓgol, walla ɓuuɓngol nanndungol e Rice-Krispies so memii ɓalndu no feewi, ko bakteriiji peewnoowo gaas gonɗi e nder ɓalndu.
5. PACE of Spread: Boɗewol walla ɓuuɓri leɗɗe ina yaaji no feewi e ko ɓuri santimeeteeruuji 1 haa 2 (0,4 haa 0,8 inch) e waktu kala, walla waasde moƴƴude caggal waktuuji 24 e ñawu nguu.
6. PERINEUM / Naatgol e nder reedu (Gangrene de Fournier): Kala ɓuuɓri, ɓuuɓri, ɓuuɓri mawndi, walla uurngol bonngol, tawi ina yahdi e rewo, reedu, reedu, reedu, walla nokku perianal.
7. PULSE & Maandeeji sepsis sistemik: Ƴeewirde ɓernde yaawnde (\(> 100\tekst{ haa }120\tekst{ bpm}\)), nguleeki mawki walla nguleeki ɓurki famɗude (\(< 36,0^\circ.text{C}\) / $96,8^\circ\text{F}di,confu ƴiiƴam ina famɗi (ƴeew sepsis njillu).
8. Noddu 911 to leyɗeele dentuɗe Amerik e Kanadaa, 112 to Dental Orop, 999 to leydi Angalteer, walla ƴeew fof limooje caɗtuɗe so tawii soklaaji gonɗi e nder ɓalndu walla yahrude yeeso jaawɗo ina woodi. Hollit laaɓndal: "Fasiitis Nekrotisan (walla Gangrene Fournier) tuumaaɗo e yaajde e sepsis."
9. Siftor diidi e keerol yaajngol ngol BOTH boɗewol yiyteteengol ngol E keeri ɓurɗi yaajde e teddeendi kuutortooɗi maande duumiinde, e winndude waktu waktu tigi-rigi e dow ɓalndu. Huutoro pentol ngam siifde ŋorol boɗewol yiyteteengol ngol e ŋorol tiiɗngol e ŋorol yaajngol ɗo ɗum mettini e yeru ŋorol, e dasheford "14:15"). Ɗuum ina rokka safroowo oo seedantaagal laaɓtungal e nder waktu gooto, no foti santimeeteeruuji e waktu gooto ñawu nguu yahri e nder yah-ngartaa.
10. Waɗde ñawɗo oo no feewi Hay huunde e hunuko (NPO: alaa ko ñaametee, ndiyam, walla pillitol) e WOTO MEƊƊI rokkude ibuprofen walla AINE goɗɗe. Sabu nguurndam ina ɗaɓɓi yahde ko yaawi gila e suudu safrirdu haa e nder suudu safrirdu ngam debridement surgical e nder anestesi generally, reedu empstoch complete. Hoto meeɗ rokkude leɗɗe cafrorteeɗe ɗe ngonaa steroid (AINE ko wayi no ibuprofen, naproxen, diklofenak, walla ketoprofen) ngam ñawu nguu ina yaawi saabaade ñawu nguu walla e nder sahaa mboros oo (varicella), sibu AINE ina maska nguleeki e mette, ina bonna cellal ɓalliwal e ɓuuɓri ƴiiƴam to leelgol ƴeewndo e ɓeydagol maayɗeele e nder fedde A fasiitis nekrotisan streptococcus.
11. Ittu denndaangal jokkere enɗam, waktuuji, jokkere enɗam, jokkere enɗam, e comci tiiɗɗi e tergal gonngal e ñawu nguu ɗoon e ɗoon. Fasciitis nekrotisant e cellulitis tiiɗɗo ina addana ɓuuɓri mawndi, tiiɗndi no haayre nii e nder waktu gooto ; jokkere dewgal walla waktu heddii e junngo walla e junngo ɓuuɓngo ina waɗa no turnique nii, ina addana ɗum taƴde iskemi.
12. WOTO MEƊƊU ɓuuɓnude, lance, pop, walla waɗde kompreseeji ngulɗi e ɓuuɓri ɓalndu luggiɗndi, mettundi, walla ɓuuɓri ɓaleeri. Ɓuuɓnude ɓuuɓri, ɓuuɓri, walla ɓuuɓri ɓuuɓri ina doola eksotoksin bakteriiji e bakteriiji guurɗi to bannge fascial planes e nder ƴiiƴam. Accu ɓuuɓri ndii ina laaɓi, ɓuuɓna ɓalndu nduu ina ɓuuɓna seeɗa e ɓuuɓri laaɓndi, yoorndi, ndi alaa ko bonnata.

Jaawgol sarde ñawu nguu e lekki pellital triage¶

Huutoro ndeeɗoo mbaydi safaara ngam seerndude sellulitis dowri mo alaa caɗeele e fasciitis nekrotisant baawɗo warde nguurndam, e gangrene Fournier, e infections Vibrio walla gangrene gaas marine.

flowchart TD
    Start["Ñawɗo oo ina wondi e ɓuuɓri ɓalndu,<br/>ɓuuɓri, ɓuuɓri terɗe, walla ɓuuɓri ɓalndu/perineal"] --> CheckRedFlags{"Mbele won banngeeji boɗeeji gonɗi e ñawu nguu?<br/>1. Naafigaagal ngal yahdaani e mbaydi ɓalndu ɓuuɓndu?<br/>2. Teddungal yaajngal haa ɓurti keeri boɗeeji yiyteteeɗi ɗii?<br/>3. Laral ɓalewal/ɓuuɓngal/njamndi WALLA ɓuuɓri ɓaleeri ɓaleeri (bullae)?<br/>4. Gaas ɓuuɓɗo les ɓalndu (crepitus) walla ɓuuɓri leɗɗe?<br/>5. Ɓoornugol ɗoon e ɗoon e dow ɓalndu mettundu ko adii?<br/>6. Yaajde >1-2 cm/waktu WALLA Sepsis (HR >100, jiiɓru, ɓuuɓri)?"}

    CheckRedFlags -->|"EEY: Kala bannge boɗeejo NSTI gooto"| SurgicalEmergency["ƊAƊƊI ƊI ƊIƊI E SEPSIS (Fasiitis Nekrotik Tuumaaɗo):<br/>1. Noddu 911 / 112 / 999 walla yah to opitaal mawɗo ER JOONI<br/>2. Siftor keeri boɗeeji + keeri teddungal e binndol & winndu TIME<br/>3 tigi-rigi. Waɗde hay huunde e hunuko (NPO) ngam ɓuuɓnude ɗum ɗoon e ɗoon WALLA<br/>4. WOTO ndokku Ibuprofen/AINE; ittu denndaangal jeewte/ringooji"]

    SurgicalEmergency --> HospitalPath["Porotokol tati doole opitaal:<br/>1. Ƴeewndo / Debridement ko yaawi (WOTO leeltu ngam MRI/CT)<br/>2. IV Ñawbuuli jaajɗi (Vankomisin/Linezolid + Pip-Tazo/Karbapenem)<br/>3. IV Kilindamisin (walla Linezolid) ngam haɗde peewnugol tooke ribosom bakteriiji"]

    CheckRedFlags -->|"ALAA"| CheckLocation{"Ƴeewto nokkuuji Anatomiiji ɓurɗi bonde<br/>e Ƴeewndorɗe Pathogen keertiiɗe"}

    CheckLocation -->|"Skrotum, ƴiiƴam, ƴiiƴam, ƴiiƴam, walla ƴiiƴam<br/>(Haa teeŋti e jabet walla e dow SGLT2)"| FournierAlert["TUUMƊO FOURNIER GANGRENE:<br/>Departemaa Emergency Hospitaal ko yaawi<br/>Ina haani ƴeewndo urologique/opération générale ko yaawi & antibiotik IV"]

    CheckLocation -->|"Gite / gite (naafigaagal e dille gite)<br/>WALLA Yeeso Caka ('Danger Triangle' nofru/leppi dow)"| OrbitalAlert["Tuumaaɗo sellulit orbital walla trombose sinus kavernous:<br/>Yah to suudu safrirdu ɗoon e ɗoon ngam waɗde antibiyotik IV & CT Scan"]

    CheckLocation -->|"Ndiyam maayo ngulɗam / oyster raw / ɓuuɓri ndiyam ɓuuɓɗam<br/>WALLA ɓuuɓri luggiɗndi / ɓuuɓri daabaaji"| SpecialBug["Tuumaaɗo Vibrio vulnificus, Aeromonas, walla Clostridium:<br/>Yah to suudu safrirdu ɗoon e ɗoon (ina waawi waylude nekrosis e nder waktuuji <6)"]

    CheckLocation -->|"Hay heen gootal e ko limtaa dow koo : Ɓoornugol pinndi-boɗewol ɓuuɓngol seeɗa,<br/>teddere ɓuuɓnde haa ɓuuɓnde tan, vitals no woorunoo"| SimpleCellulitis["Sellulit walla Erisipelas mo alaa ko saɗti:<br/>- Njillu safaara ñalnde heen ko yaawi ngam heɓde antibiyotikuuji gonɗi e hunuko/IV<br/>- Keeri limtaaɗi e pen + waktu ; toownude tergal dow ɓernde<br/>- Yah to ER ɗoon e ɗoon so tawii nafoore ndee ina ɓeydoo walla ina taƴa penndi e yaawre"]

Anatomi e patofisiyoloji : Hol ko waɗi Fasiitis Nekrotik ina yaawi saabaade ɗum e hol ko waɗi antibiyotik tan ina waasa¶

Ngam faamde hol ko waɗi safroowo ina waawi safrude erisipelas walla cellulitis e balɗe 5 haa 10 e nder balɗe 5 haa 10, tawi noon fasciitis necrotizing ina wara so wonaa tawa doktoor ina uddita tergal ngal e nder suudu safrirdu, ƴeew laabi ɓalndu neɗɗo e to botom gila dow :

1. Epidermis e Dermis toowɗo (Target Erysipelas): Ko ɓuuɓri ɓalndu dowri, ɓuuɓndi. Infections ɗoo ina mbaɗa ɓuuɓri boɗeeri, toowndi, keeriindi ɓuuɓndi, step-off.
2. Dermis luggiɗiiɗo e ƴiiƴam les ɓalndu toowɗam (Target de cellulitis): Ina heewi ƴiiƴam kapilaar tokosam. Sabu ƴiiƴam ina ilna e nder ɓalndu, antibiotikuuji gonɗi e hunuko walla e nder ƴiiƴam ina mbaawi yettaade bakteriiji ɗii no feewi, tee ɓalndu nduu ina wayi no boɗeejo, ɓuuɓɗo, ɓuuɓɗo gila e fuɗɗoode.
3. Fascia luggiɗnde (Paandaale Fasciitis Nekrotisant) e Ɓoggi ƴiye (Paandaale Mionekrosis):
4. Les laral ɓuuɓngal ɓuuɓngal les ɓalndu ina woodi fascia luggiɗnde, woni lefol danewol tiiɗngol, ɓuuɓngol, ɓuuɓngol, ɓuuɓngol, ngol taarii ƴiye no ɓuuɓri soseeji nii.
5. Nokku gonɗo e dow ɗaɗol fascia luggiɗngol ngol ina jogii reentaare naftoore seeɗa no feewi, ƴiiƴam ina famɗi no feewi. So bakteriiji nekrotik naatii e ndee dingiral (so tawii ko rewrude e ɓuuɓri tokosiri e nder ɓalndu, ɓuuɓri seppo, ɓuuɓri ƴiiƴam, WALLA rewrude e ƴiiƴam jooɗtooɗam e nder ɓalndu ɓuuɓndu tawa ɓuuɓri yi’eteendi e nder ɓalndu ina woodi), ɗi ndoga e dow laawol mawngol fascial no wildryfire s racing les wildryfire s.
6. No bakteriiji ɗii keewirta nii, ina njaltina eksotoksin, streptolisin, kolagenaas, e hialuronidaas baawɗo saabaade trombose (ɓuuɓri ƴiiƴam) denndaangal ƴiye tokoose gonɗe e dow ɓalndu ummotooɗe e ɓalndu rewrude e fascia ngam ñamminde ƴiiƴam e ɓalndu dow.
7. Ko waɗi ɗum sosde "Stage 1 Diagnostic Trap": E nder waktuuji 6 haa 18 gadani ɗii, fascia luggiɗka ina ɓuuɓta, nerves luggiɗe ina ngulla e nder ɓuuɓri (10/10 pain out of proportion), tawi noon ɓalndu dow nduu ina nanndi e no woorunoo walla tan ina nanndi e pinndi seeɗa. Ko caggal ɗuum tan, caggal nde ƴiye perforaaji ɓuuɓɗe ɗee njuumti haa laaɓi e ɓalndu nduu, ɓalndu dow nduu ina wayloo dusky blue-gray, ina ƴellitoo ɓuuɓri ƴiiƴam mboɗeeri, ina yaha ina ɓuuɓtoo haa laaɓa nde ƴiye gonɗe e dow ɗee maayata.
8. Ko waɗi antibiotik IV tan waawaa safrude ɗum: Sabu denndaangal ƴiye ñamlooje fascia luggiɗɗe ɗee ko ɓuuɓɗe (trombose) e ƴiye maayɗe ina njogii cirkulaasiyoŋ ƴiiƴam zero, antibiotikuuji nder ƴiiƴam cirƴata e nder ƴiiƴam e ɓanndu mbaawaa naatde e fascia nekrotik. Ko ƴulɓe seernaaɓe tan mbaawi ittude ƴiiƴam maayɗam, ɓuuɓɗam tooke.

Njiylawu hoore e hoore : Fasiitis nekrotisant e sellulit e gangrene gaas e trombose ƴiiƴam luggiɗɗam (DVT)¶

Huutoro ndeeɗoo tabalde ƴeewndo safaara (ina waɗi Fedde Ñawuuji Ɓooyɗi Amerik [IDSA], Fedde Adunaare Opereeji Emergency [WSES], e UK NICE laabi) ngam seerndude ñawbuuli nekrotik e miijooji mum en keewɗi :

Daawe 3 kilinik e yahrude yeeso Fasciitis Nekrotisan¶

Sabu ñawɓe ina pamɗi hollirde denndaangal maale defte janngirɗe e nder waktu gadano oo, safrooɓe ina njiyloo fasciitis necrotizing e nder daawal tati gonngal e sahaa :

Daawe 1 : Daawe puɗɗaaɗe / ko adii nekrotik (waktuuji 0 haa 12, ƊEƊƊE ƊEƊƊE ƊEƊƊE NGURNDAM)¶

• Maandeeji nokkuuji: Boɗewol walla ɓuuɓri pinndi ɓuuɓndi, ndi laaɓtaani, ɓalndu ngulndu, e induration woody-hard luggiɗndu les ɓuuɓri.
• The Key Clue: Nafoore luggiɗnde tiiɗnde, nde ustataako, e teddungal e toɓɓere lewlewndu, nde yaaji santimeeteeruuji keewɗi haa ɓurti ŋoral yiyteteengal e ɓuuɓri, nde yahdaani e no ɓalndu nduu wayi famɗude nii.
• Maandeeji gonɗi e nder ɓalndu: Ɓuuɓri nanndundi e grippe, ɓuuɓri, nguleeki, ɓuuɓri ɓernde yaawndi ndi laaɓaani (\(> 100\text{ bpm}\)), ɓuuɓri, ɓuuɓri, walla ɓuuɓri ndiyam (ko eksotoksiin superantigen streptocoque saabi ɗum). Hakkille majjere: Heewi majjere ko "grippe e ƴiiƴam ɓuuɓɗam", "gout bonɗo", walla "cellulitis ɓuuɓɗo gadano."

Daawe 2 : Daawe hakkundeeje / iskemi (waktuuji 12 haa 24)¶

• Maandeeji nokkuuji: Nokkuure ɓalndu ina wayloo gila e roosa haa e ɓurɗo ɓuuɓde, ɓuuɓɗo, ɓuuɓɗo, walla ɓuuɓɗo ɓuuɓɗo mo keeri mum laaɓtaani. Ɓuuɓri (bullae) ina ɓuuɓtoo e dow leydi, ko adii fof ina heewi ndiyam serous boɗejam, ina yaawi heewde ndiyam ƴiiƴam boɗejam-boɗejam walla maroon.
• Maandeeji gonɗi e nder ɓalndu: Ɓuuɓri mawndi (walla ustude nguleeki), jiiɓru, ŋakkeende ndiyam, ɓeydagol laktat ƴiiƴam, e ŋakkeende ƴiiƴam.

Daawe 3 : Daawe cakkitiiɗe / Nekrotik & Gangren (Waktuuji 24 haa 48+)¶

• Maandeeji nokkuuji ɗii: Ɓuuɓri ɓaleeri ndii ina ɓuuɓtoo, ina ɗacca eschar nekrotik ɓaleejo, ɓaleejo e ɓuuɓde, ɓuuɓnde, ɓuuɓnde ndiyam "ndiyam" ɓuuɓɗam.
• Nummbness Paradoxical: Naamne gonɗe e Stade 1 ɗee ɗoon e ɗoon wayliima wonta muumre timmunde (anesthésie cutanée) sabu ƴiye cutaneeje dogduɗe e fascia ɗee maayii haa laaɓi. Krepitus (gaas ɓuuɓɗo) ina waawi nanngeede e les koppi.
• Maandeeji sistemik: Refraktoor ɓuuɓri septik, ɓuuɓri nder ƴiiƴam (DIC), ɓuuɓri ƴiiƴam, ɓuuɓri ƴiiƴam (ARDS), e ɓuuɓri ɓernde.

Faamde sifaaji 4 mikroo-biyoloji ɗi mborosaaji softuɗi nekrotikaaji¶

Anndude hol sifaa njiylawu walla ngonka safaara addani ñawu nguu, ina wallita safrooɓe e nder suudu safrirdu suɓaade mbaydi antibiotik laaɓtundi, baawndi hisnude nguurndam e nder hojomaaji 15 gadani ɗii :

Jeertinaango keeriiɗo : Gangrene Fournier (NSTI perineal, genital, e groin) e jokkondiral gonngal e SGLT2¶

Gangrene Fournier ko ñawu nguu ina yaawi yahrude yeeso (Tipe I) perineum, nokku perianal, ƴiiƴam, ƴiiƴam, walla vulva/labia. Sabu diƴƴe fascial perineum (fascia Colles, fascia Buck, e fascia Dartos) ina njokkondiri no feewi e fascia Scarpa mo ɓalndu yeesooru, ñawu nguu fuɗɗotoo ko e saraaji ɓuuɓri perineum tokosiri, ɓuuɓri bartholin e ɓuuɓri vulva ina waawi ɓuuɓde ɓuuɓri ƴiiƴam fof haa dow ribcage e nder waktuuji seeɗa.

Hol ɓurɗo waawde heɓde Gangrene Fournier ?¶

1. Nyawɓe jabet, alkol, ŋakkere teddeendi, cirrhose, walla ŋakkere cellal ɓalli.
2. Nyawɓe ƴettuɓe leɗɗe kaɗooje SGLT2 : Jeertinaali kisal jowitiiɗi e FDA Amerik, Fedde Oropnaare Leɗɗe (EMA), e MHRA Angalteer ina njeertina wonde ñawɓe ƴettuɓe leɗɗe kaɗooje SGLT2** (empagliflozin [Jardiance], dapaglixigaflozin, walla F [Invokana], walla ertugliflozin [Steglatro]) wonande jabet fannu 2, ŋakkere ɓernde, walla ñawu nguu ina ɓeydoo heewde gangrene Fournier (sabu suukara toowɗo yaltinaaɗo e ƴiiƴam ina ñammina bakteriiji e funeeɓe perineal).

Banngeeji boɗeeji Gangrene Fournier (ina ɗaɓɓi seppo ko yaawi e nder suudu safrirdu)¶

• Nafoore ɓuuɓnde, ɓuuɓnde, ɓuuɓnde, walla ɓuuɓnde e nder reedu, e nder reedu, e nder reedu, e nder reedu, walla e saraaji reedu.
• Ɓuuɓri yaawndi yaajde e boɗewol ɓuuɓngol (walla ɓuuɓri njamndi/ɓaleeri) e ɓalndu nduu.
• Gaas ɓuuɓɗo les ɓalndu walla labbi (crepitus) walla uurngol bonngol, ɓuuɓngol, ɓuuɓngol.
• Feere, ɓuuɓri, ɓernde yaawnde, ɓuuɓri, walla suukara toowɗo e nder ƴiiƴam/DKA.
• Golle ko yaawi: Woppu kala ko ina haɗa SGLT2 ɗoon e ɗoon, njahaa to suudu safrirdu too. (Sabu gangrene Fournier puɗɗanooɗo e worɓe ina addana neɗɗo muusde no feewi e ɓuuɓri ƴiiƴam, safrooɓe urgence ina poti ƴeewtaade ɗi ɗiɗi fof torso testikulaar e gangrene Fournier ɗoon e ɗoon.)

Ballal gadanal : No mbaɗata "Pen Border & Time Test" e peewnugol ER¶

So aɗa fadi ambulance walla aɗa yaha to departemaa emergency, rewa e ɗeeɗoo geɗe laaɓtuɗe ko adii opitaal :

Ɗatal 1: Test Marker duumotooɗo mo diidi ɗiɗi (e waktuuji waktuuji)¶

1. Ƴettu pentol balɗe walla maande duumiinde fine-tip.
2. Siftor lawol tiiɗngol e dow ŋoral yiyteteengal yaajngal e mbaydi ɓalndu pinndi/boɗeeri.
3. Toɓɓu no feewi e junngo wooto laaɓngo fuɗɗoraade santimeeteeruuji keewɗi e dow ɓalndu no woorunoo, yahde nder feewde e boɗewol ngol ; ƴettude laabi ŋeñɗi ɗo ñawɗo oo adii nande teddeendi luggiɗndi laaɓtundi. (So tawii doggol teddeendi ŋeñol ngol ina jooɗii 2 haa 5 santimeeteer e yaasi doggol boɗewol tiiɗngol ngol, haalan ER triage nurse ɗoon e ɗoon : ngolɗoo "teddeendi ɓurndi eritema" ko maande yaajde fascial luggiɗnde.)
4. Winndu waktu tigi-rigi (yeru, 16:30) to bannge ɓalndu no woorunoo sara liggey oo.

Ɗatal 2 : Joɗɗinde e ustude¶

• So tawii ñawɗo oo ina jogii Fasciitis Necrotizing Suspected walla Sepsis (ɓernde ina yaawi, nguleeki, ɓuuɓri 10/10 tiiɗndi, ɓuuɓri): Waɗde ñawɗo oo ina lelii ɓurɗo famɗude walla ina weltii tawa tergal ngal ina fooftoo neutral to bannge ɓernde (woto **ƴettu tergal toowngal dow necrotizing so tawii ko syndrotising compar.i toowgol ina usta ɓuuɓri ƴiiƴam e nder ƴiiƴam ɗam woni ko e iskemi).
• So tawii ñawɗo oo ina selli Cellulitis superficielle ɓuuɓɗo, mo alaa caɗeele (ko doktoor ƴeewti ɗum tawo, vitals normal, nafoore ɓuuɓnde): Toownude koyngal walla junngo ɓuuɓngo e dow pillows dow tolno ɓernde ina wallita gravity drain edema inflammatory benign fluid faster.

Ɗatal 3: Ko waɗi safrooɓe opitaal ina poti HAƁDE leeltinde seppo ngam waɗde MRI walla CT scan¶

Famde kuule safrirde ina wallita ɓesnguuji e wallitde ngam ƴeewde ko yaawi : - E fawaade e jamirooje Fedde ñawuuji mboros Amerik (IDSA) e Fedde winndereere toppitiinde seppooji (WSES), fasciitis necrotisant ko ñawu nguu e nder safaara e nder seppooji. - So tawii ultrasound yaawɗo e leeso walla CT scan mo hojomaaji 5 ina waawi sahaa e sahaa fof yiytude ɓuuɓri gaas ina rewi e fascia luggiɗka, waasde gaas e radiyoo walla CT scan haɗataa fascia nekrotisant (haa teeŋti e Strep mo sifaa II Groupe A e mo sifaa III Vibrio, mo gas produce*). - Waɗde waktuuji 2 haa 4 ngam ƴeewde MRI e ñawɗo mo nganndu-ɗaa ina laaɓi walla mo dartaaki ina ɓeyda maayde laabi ɗiɗi. E nder ɗuum, doktoor oo ina nawta ñawɗo oo to suudu safrirdu too (walla waɗa heen hojomaaji 2 to leeso "Test Finger" e nder anestesi nokkuyankeewo: waɗde \(2\epcision fascials in if.\) the} ƴiiƴam, ina ooze ndiyam "ndiyam ɓuuɓɗam" ɗam, ina addana junngo gonngo e gannde ɓuuɓde e dow dingiral ƴiiƴam tawa alaa ko reennata ɗum, fasciitis nekrotisan ina tabitina, debridement timmuɗo fuɗɗotoo ɗoon e ɗoon). - Ko waɗi Kilindamisin (walla Linezolid) ina ɓeydee e antibiyotikaaji IV : Antibiyotikaaji gonɗi e ɓalndu nduu ko wayi no penisilin walla piperasilin-tazobaktam ina mbara tan bakteriiji peccitooji e golle ; so tawii tiriliyoŋaaji bakteriiji Strep Groupe A ina paccira e nder fascia, ɗi ngoppa feccude, ɗi njaltina tan tooke superantigen baawɗe warde (** "Effet Eagle"**). Ɓeydude klindamisin e nder ƴiiƴam (\(600\text{ haa }900\text{ mg}\) IV kala waktuuji 8) walla linezolid ina jokkondiri no feewi e bakteriiji 50S ribosom, ɗoon e ɗoon ina udda usine peewnoowo tooke ñaamoowo teewu e Shok antigen.

Binndol jokkondiral laaɓtungol wonande 911 / 112 / 999 e ƴeewndo safrirde¶

So a arii e departemaa emergency mo yimɓe heewɓe ngoni, woto wiy tan "miɗo wondi e mboros" walla "koyngal am ina ɓuuɓi." Huutoro ndee winndannde ɓurnde himmude:

"Miɗo haani ƴeewndaade ko yaawi. Ngolɗoo boɗewol ɓalndu e [koyngal / junngo / ŋoral] ina sikkaa e binndol e [Waktu], tee ina yaaji [X santimeeteeruuji] e nder waktu ɓennuɗo oo. Ñawɗo oo ina jogii 10-e-10 nafoore luggiɗnde, nde yahrata ko e keeri boɗeeji / ɓalndu purple [e/walla ɓalndu purple naatgol ƴiiƴam e dow reenoowo SGLT2] e ɓuuɓri ɓernde [BPM]. Min ngoni e sunaare e Fasciitis Necrotizing [walla Gangrene Fournier] e min njooɗii e ñawɗo oo Hay huunde e hunuko (NPO) ngam ƴeewndaade ko yaawi."

Naamne keewɗe naamneede¶

Hol no mbaawirmi anndude ko seerndi cellulitis ordinateer e fasciitis nekrotisant puɗɗorɗo hade kala ɓuuɓri purple feeñde ?¶

E nder cellulitis ordinateer, ɓalndu nduu ina nanndi e roosa walla boɗeejo, ina nanndi e nguleeki e ɓuuɓri, kono ɓuuɓri ndii ina heddii e nder ɓuuɓri boɗeeri ndii, neɗɗo oo ina heewi nanndude e deeƴre. E fuɗɗoode Fasciitis nekrotizing Stage 1, ñawu nguu ina doga haa les ɓuuɓri ndii e dow fascia, ko ɗuum waɗi ɓalndu nduu ina waawi yiyeede ina ɓuuɓna walla ina ɓuuɓna tan tawa neɗɗo oo ina heɓa ɓuuɓri 10-e-10 ɓuuɓri luggiɗndi, ɓuuɓri ndi ina yaaji santimeeteeruuji keewɗi wooddy visibled-hard system pa, maale sepsis ko wayi no ɓuuɓri dogdu, nguleeki, ɓuuɓri, walla ɓuuɓri ƴiiƴam.

Hol ko waɗi ƴettude ibuprofen (Advil, Motrin) walla naproxen ina bonna ngam ñawu nguu ina yaawi saabaade ñawu nguu walla e sahaa mboros oo ?¶

Leɗɗe cafrorteeɗe ɗe ngonaa steroid (AINE) ko wayi no ibuprofen ina maska ​​nguleeki mawki e mette luggiɗe tiiɗɗe, ɗe njeertina safrooɓe e fasciitis nekrotisant (fasciitis nekrotisante) ko yaawi, ina addana ɗum leeltude e yah-ngartaa safrirde. Yanti heen, wiɗtooji safaara e laboratuwaaruuji ina kollita wonde AINE ina bonna mbaawka ƴiiƴam ɓalejam (neutrophiles) ngam reende e halkude bakteriiji Streptococcus Groupe A, tawi ina ɓeyda peewnugol sitokineeji ɓuuɓɗi jokkondirɗi e mboros Streptococcus Toxic Shock Syndrome.

Hol ko waɗi nafoore mettunde e koyngal ɓuuɓngal, ɓuuɓngal, ɗoon e ɗoon majja, wonta ɓuuɓɗo ?¶

So tawii ñawu nguu ina muusi no feewi, ina yaawi ɓuuɓde, ɗoon e ɗoon woppii ñawu nguu, ina nanndi e maayde e toɓɓere (anesthésie cutanée), ko maande catastrophique Stage 3 emergency, wonaa cellal. Firti ko ñawu nekrotisant e dow fascia luggiɗka nguu, ɓuuɓnii denndaangal ƴiye, wari haa laaɓi ƴiye gonɗe e ɓalndu nduu ; ko seppo ko yaawi ina haani ngam hisnude nguurndam neɗɗo oo.

Hol ko waɗi antibiotik tan safrataa ñawu nguu tawa seppo waɗaaka ?¶

Antibiyotikuuji gonɗi e nder ƴiiƴam ina njaha e nder ɓanndu e nder ƴiiƴam ɓuuɓɗam. E nder fasciitis nekrotisant, tooke bakteriiji ina ngadda trombose timmuɗo (ɓurɗo ɓuuɓde) e denndaangal ƴiye jokkondirɗe e fasciitis luggiɗnde e ƴiye leslese ; sabu ƴiiƴam zero ina ilna e nder ƴiiƴam maayɗam, ɓuuɓɗam, antibiotikuuji gonɗi e nder ƴiiƴam mbaawaa yettaade bakteriiji nder fascia, ɗum noon ko huunde waɗɗiinde ittude (debridement) ƴiiƴam maayɗam ɗam ɗoon e ɗoon.

Fuɗɗoode ƴeewtaama¶

• Fedde ñawuuji mborosaaji Amerik (IDSA, Amerik): Laabi gollorɗi ngam ƴeewde e ƴellitde ñawuuji ɓalndu e ƴiye softeende (Stevens et al., ñawbuuli mborosaaji kilinik, ƴeewndo feeñninde fasciitis nekrotisant e vanzolicomy, vanzolicom +surgical piperasilin-tazobaktam/karbapenem + klindamisin gonɗo e ɓuuɓri).
• Fedde Adunaare toppitiinde ko feewti e seppooji (WSES) e Fedde winndereere toppitiinde seppooji Orop (SIS-E): WSES/GAIS/SIS-E/WSIS/AAST Laabi seppooji winndereeji ngam ñawɓe wonduɓe e ñawbuuli ɓalli e ƴiye softuɗe (Sartelli et al., Jaaynde winndereere seppooji Sta-NSTIge1 anndinde, gangrene Fournier, e porotokolle ƴeewndo koppi nder golle).
• Fedde Fuɗnaange ngam Opereeji Ɓoornugol (EAST) e Fedde Ameriknaare ngam Opereeji Ɓoornugol (AAST, Amerik): Laabi njuɓɓudi golle ngam Ɓoornugol Ɓoornugol Soft Tissue.
• Nokkuuji toppitiiɗi ko fayti e ñawuuji (CDC, leyɗeele dentuɗe Amerik) e Fedde toppitiinde kisal cellal to Angalteer (UKHSA / NICE, leydi Angalteer): Ardorde safaara e ñawuuji streptokok (iGAS) gonɗi e nder fedde A, e fasciitis nekrotisant, e Vibrio vulnificus Marine Wound Infe.
• Njuɓɓudi Amerik toppitiindi ko fayti e nguura e leɗɗe (FDA) e Fedde toppitiinde ko fayti e leɗɗe Orop (EMA): Jokkondiral kisal leɗɗe e dow fasciitis nekrotisant (gangrene de Fournier) jokkondirɗo e SGLT2.

Ardiiɓe jokkondirɓe¶

• Sepsis e anndinde soklaaji septik
• Taƴe, ɓuuɓri, e ballal gadanal laɓɓinde gaañiiɓe
• Gaññeeje ɓuuɓɗe e sindrom kompartiment akut
• Ɓoornugol daabaaji e reentaade ñawu nguu
• Barbs stingray, ƴiye ƴiye maayo, e toppitagol gaañanɗe maayo