Gas gangrene
Description:
Gangrene gas (or anaerobic gangrene, мионекроз) — an infection which is caused by growth and reproduction of klostridialny microflora in body tissues. Growth of this microflora is possible only in the absence of oxygen (anaerobno), however disputes can remain a long time on air.
Symptoms of Gas gangrene:
In 6 hours after acquisition disturbances of the general state with tachycardia and fever arise a microbe of ability to infection. Integuments of gray-blue color. The wound is sharply painful, edges its pale, edematous, lifeless, a wound bottom dry. Coloring of the muscles seen in a wound reminds boiled meat. When pressing vials of gas with an unpleasant sweetish and putrefactive smell are allocated for edges of a wound from fabrics. At palpation the typical pokhrustyvaniye (crepitation) is defined. The condition of the patient quickly worsens, there comes shock.
Gas gangrene is characterized by a number of specific symptoms some of which are pathognomonic; most of them is directed to identification of the formed gas:
1. The ligature symptom (Melnikov's symptom) — at deligation on the site of an extremity in 15-20 minutes thread begins to stick into skin because of swelling of an extremity.
2. The symptom of the pallet — at percussion by the metal pallet on the struck area is heard characteristic crackling, with a tympanic shade a sound. The same sound can be heard when shaving integuments around a wound (a razor symptom).
3. The champagne cork symptom — at extraction of a tampon (napkin) from the wound course is heard cotton.
4. Krause's symptom — intermuscular accumulations of gas on a x-ray film are visualized in the form of "fir-trees".
Reasons of Gas gangrene:
The disease is caused preferential by bacteria of a sort of clostridiums which live in the soil and street dust. The wounds contaminated by the earth, having wound pockets and sites of devitalized fabric, and also badly krovosnabzhayemy fabrics and which did not undergo primary surgical treatment are predisposed to gas gangrene. The activator quickly gains ability to infection, emitting the gas-forming and dissolving fabrics exotoxins which promote bystry spread of an infection.
Main activators:
* Clostridium perfringens (90% of cases)
* Clostridium septicum
* Clostridium histolyticum
* Clostridium novii
* Clostridium fallax
* Clostridium bifermentans
* Clostridium sordellii
Treatment of Gas gangrene:
Lampasnye cuts of skin, muscles, covers with excision of devitalized fabrics and sites, suspicious on a necrosis. Establishing outflow of pus from a wound with washing by solution of peroxide of hydrogen and antibiotics; a wound leave open. Absolute rest of an extremity. Penicillin to 20 — 40 mln units a day (2 — 3 times a day intravenously) within 10 — 14 days, tetracycline. Antigangrenous serum and anatoxin are inefficient both at treatment, and when performing prevention of gas gangrene. At bystry increase of intoxication — guillotine amputation of an extremity. Influence of oxygen under pressure is effective, however surgical removal of the center of an infection is not excluded from a wound to which indications are clinical and radiological signs of gas gangrene with microscopically proved existence of clostridiums in a wound.
Prevention consists in the timely qualified primary surgical treatment of all contaminated wounds.
