GANGRENE
TREATMENTS |
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Gas gangrene is a medical emergency
because of the threat of the infection rapidly spreading via the
bloodstream and infecting vital organs. It requires immediate
surgery and administration of antibiotics.
Areas of dry gangrene that remain free from infection (aseptic) in
the extremities are most often left to wither and fall off.
Treatments applied to the wound externally (topically) are generally
not effective without adequate blood supply to support wound healing.
Assessment by a vascular surgeon, along with x rays to determine
blood supply and circulation to the affected area, can help
determine whether surgical intervention would be beneficial.
Once the causative organism has been identified, moist gangrene
requires the prompt initiation of intravenous, intramuscular, and/or
topical broad-spectrum antibiotic therapy. In addition, the infected
tissue must be removed surgically (debridement), and amputation of
the affected extremity may be necessary. Pain medications
(analgesics) are prescribed to control discomfort. Intravenous
fluids and, occasionally, blood transfusions are indicated to
counteract shock and replenish red blood cells and electrolytes.
Adequate hydration and nutrition are vital to wound healing.
Although still controversial, some cases of gangrene are treated by
administering oxygen under pressure greater than that of the
atmosphere (hyperbaric) to the patient in a specially designed
chamber. The theory behind using hyperbaric oxygen is that more
oxygen will become dissolved in the patient's bloodstream, and
therefore, more oxygen will be delivered to the gangrenous areas. By
providing optimal oxygenation, the body's ability to fight off the
bacterial infection are believed to be improved, and there is a
direct toxic effect on the bacteria that thrive in an oxygen-free
environment. Some studies have shown that the use of hyperbaric
oxygen produces marked pain relief, reduces the number of
amputations required, and reduces the extent of surgical debridement
required. Patients receiving hyperbaric oxygen treatments must be
monitored closely for evidence of oxygen toxicity. Symptoms of this
toxicity include slow heart rate, profuse sweating, ringing in the
ears, shortness of breath, nausea and vomiting, twitching of the
lips/cheeks/eyelids/nose, and convulsions.
The emotional needs of the patient must also be met. The individual
with gangrene should be offered moral support, along with an
opportunity to share questions and concerns about changes in body
image. In addition, particularly in cases where amputation was
required, physical, vocational, and rehabilitation therapy will also
be required. |
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