Gas gangrene

Essence of gas gangrene and premises of its emergence

Gas gangrene is a mephitic gangrene which develops owing to extensive damages of fabric. As a rule, it is caused: gunshot wounds, the fragmentary hurt wounds, open fractures and separations of extremities, wounds of a large intestine, other severe injuries. The scale of damages of tissues of body is more and the more they are contaminated, the conditions for development of an infection are more favorable. The causative agent of gas gangrene – anaerobic microbes which eat the devitalized cells which are in a wound. In the course of reproduction these microbes emit specific gas. It not only is one of characteristic symptoms of existence of an infection, but also causes extensive intoxication of the vital systems of an organism. As a rule, the infection develops within the first days from the moment of an injury, but in certain cases symptoms of a disease appear considerably later. Let's note also that at the diagnosis gas gangrene treatment has to be carried out to the most short time as the disease is extremely dangerous and quite often leads of the patient to death.

Gas gangrene – symptoms and a clinical picture

Now doctors allocate 4 forms of a disease of gas gangrene.

Classical gas gangrene is characterized by local hypostasis of the damaged fabrics which gradually turns into necrosis and is followed by intensive gas generation. Skin around a wound becomes pale, becomes covered by brown spots. At a palpation from it vials of gas and sanious liquid are allocated. The damaged fabrics get a gray-green shade and in several hours finally die off with allocation of a putrid smell. Classical gas gangrene is not followed by release of pus.

Edematous and toxic form of a disease of gas gangrene. Around the field of damage there is extensive hypostasis which gradually extends on even healthy fabrics. There is no pus – gas generation – weak. Hypostasis extends extremely quickly. As a result, the necrosis of muscular tissue is shown practically right after getting injured.

Phlegmonous gas gangrene – symptoms, unlike other forms, are expressed poorly. In most cases necrosis of fabrics is limited to the small site, but process is followed by release of pus and gas generation. Temperature of an integument does not decrease, there are no spots on skin and hypostases –.

Putrefactive form of gangrene. Develops very violently with intensive disintegration of fabrics. Omertveny of muscles comes extremely quickly with department of purulent contents and liberation of gas. Speed of development of an infection is explained by symbiosis of anaerobic and putrefactive bacteria. At the same time the causative agent of gas gangrene emits toxins which destroy proteins of fabrics and walls of vessels that involves emergence of secondary erosive bleedings. There is also one more characteristic sign: if the previous forms of a disease are most often localized on extremities, then putrefactive gas gangrene generally extends in the field of a mediastinum and a rectum.

As for the general symptoms of a disease, it is possible to allocate a number of the most typical symptoms of gas gangrene:

• lowering of arterial pressure;
• depression or, on the contrary, too strong excitement;
• tachycardia;
• fervescence to 38-39 degrees;
• painful sleeplessness;
• dehydration;
• hurried breathing;
• high-growth anemia.

Gas gangrene which treatment was begun out of time leads to a bystry lethal outcome (within 2-3 days). Sometimes death comes much quicker (so-called "instant" gas gangrene). In the latter case the person will be saved by only an urgent operative measure and the qualified medical care.

Gas gangrene – treatment and prevention

At the slightest suspicions on existence of an infection it is necessary to begin active surgical treatment. The doctor has to carry out broad opening of each damaged site and excise devitalized fabrics. At the same time also the correct drainage for withdrawal of purulent contents of a wound is provided. At the edges of the damaged site antibiotics of a broad spectrum of activity are entered. If there is a confirmed diagnosis gas gangrene, treatment consists in immediate amputation of an extremity with the subsequent hyperbaric oxygenation (the patient is regularly placed in the cell with the established high pressure (no more than 3 atm).

Right after detection of gas gangrene to the patient intensive infusional care about use of plasma, albumine, proteins and solutions of electrolytes is appointed. If gas gangrene which symptoms demonstrate emergence of anemia develops, the patient carries out hemotransfusion with simultaneous introduction of antibiotics.

If the causative agent of gas gangrene is revealed, doctors use monovaletny antigangrenous serums. If is not present, then to patients polyvalent serums widely of an action spectrum are entered.

As for the general actions. Patients with the diagnosis gas gangrene are isolated from other patients. Near them the round-the-clock sisterly post will be organized. All tools and bed linen are carefully processed. Let's notice that disputes of bacteria perish only at repeated boiling therefore for disinfection it is better to use air or steam sterilization with use of the special equipment.

Observance of rules of precaution at treatment of gas gangrene concerns also to health workers. They have to carry out all procedures in rubber gloves. The last are regularly disinfected. Dressing and other expendables are destroyed right after the end of bandaging.