Gangrene physical examination: Difference between revisions

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|+<big>''' Table 1. Summary of [[Physical Examination]].'''</big>
|+<big>''' Table 1. Summary of [[Physical Examination]].'''</big>
! align="center" style="background: #00CED1; width: 100px;" |{{fontcolor|#FFF|System}}
! align="center" style="background: #00CED1; width: 120px;" |{{fontcolor|#FFF|System}}
! align="center" style="background: #00CED1; width: 900px;" |{{fontcolor|#FFF|Findings}}
! align="center" style="background: #00CED1; width: 900px;" |{{fontcolor|#FFF|Findings}}
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| style="padding: 2px 2px; background: #E6E6FA; font-weight: bold" |[[General Appearance]]
|align="center" style="padding: 2px 2px; background: #E6E6FA; font-weight: bold" |[[General Appearance]]
| style="padding: 2px 2px; background: #F5F5F5;" |[[Patient]] with [[gangrene]] usually appears [[conscious]], [[coherent]], and not in [[cardiorespiratory distress]].
| style="padding: 2px 2px; background: #F5F5F5;" |[[Patient]] with [[gangrene]] usually appears [[conscious]], [[coherent]], and in [[cardiorespiratory distress]].
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| style="padding: 2px 2px; background: #E6E6FA; font-weight: bold" |[[Vital Signs]]
|align="center" style="padding: 2px 2px; background: #E6E6FA; font-weight: bold" |[[Vital Signs]]
| style="padding: 2px 2px; background: #F5F5F5;" |[[Blood pressure]] is usually low.
| style="padding: 2px 2px; background: #F5F5F5;" |[[Patient]] is usually [[hypotensive]] and [[febrile]]. <ref name="pmid7934492">{{cite journal| author=Chelsom J, Halstensen A, Haga T, Høiby EA| title=Necrotising fasciitis due to group A streptococci in western Norway: incidence and clinical features. | journal=Lancet | year= 1994 | volume= 344 | issue= 8930 | pages= 1111-5 | pmid=7934492 | doi=10.1016/s0140-6736(94)90629-7 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7934492  }} </ref> <ref name="pmid2659990">{{cite journal| author=Stevens DL, Tanner MH, Winship J, Swarts R, Ries KM, Schlievert PM | display-authors=etal| title=Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A. | journal=N Engl J Med | year= 1989 | volume= 321 | issue= 1 | pages= 1-7 | pmid=2659990 | doi=10.1056/NEJM198907063210101 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2659990  }} </ref>
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| rowspan="5" style="background: #E6E6FA;" ; |[[HEENT]]
| rowspan="5" align="center" style="background: #E6E6FA;" ; |[[HEENT]]
| style="padding: 2px 2px; background: #F5F5F5;" |[[Head]]:[[Head]] can be [[normocephalic]].
| style="padding: 2px 2px; background: #F5F5F5;" |[[Head]] can be [[normocephalic]].
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| style="padding: 2px 2px; background: #F5F5F5;" |[[Eyes]]: [[Eyes]] can be normal.
| style="padding: 2px 2px; background: #F5F5F5;" |[[Eyes]] can be normal.
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| style="padding: 2px 2px; background: #F5F5F5;" |[[Ears]]:[[Ears]] can be normal.
| style="padding: 2px 2px; background: #F5F5F5;" |[[Ears]] can be normal.
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| style="padding: 2px 2px; background: #F5F5F5;" |[[Nose]]:[[Nose]] can be normal.
| style="padding: 2px 2px; background: #F5F5F5;" |[[Nose]] can be normal.
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| style="padding: 2px 2px; background: #F5F5F5;" |[[Throat]]: [[Throat]] can be normal.
| style="padding: 2px 2px; background: #F5F5F5;" |[[Throat]] can be normal.
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| style="padding: 2px 2px; background: #E6E6FA; font-weight: bold" |[[Chest]] / [[Lungs]]
| align="center" style="padding: 2px 2px; background: #E6E6FA; font-weight: bold" |[[Chest]] / [[Lungs]]
| style="padding: 2px 2px; background: #F5F5F5;" |[[Gangrene]] can lead to [[sepsis]] which may manifest with decreased [[chest expansion]], and decreased [[breath sounds]].
| style="padding: 2px 2px; background: #F5F5F5;" |[[Gangrene]] can lead to [[sepsis]] which may manifest with decreased [[chest expansion]] and decreased [[breath sounds]].
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| style="padding: 2px 2px; background: #E6E6FA; font-weight: bold" |[[Cardiovascular]]
| align="center" style="padding: 2px 2px; background: #E6E6FA; font-weight: bold" |[[Cardiovascular]]
| style="padding: 2px 2px; background: #F5F5F5;" |[[Gangrene]] can lead to [[sepsis]] which may manifest with [[dynamic precordium]], [[[irregular heart rate]], [[irregular rhythm]], and with [[heart murmurs]].
| style="padding: 2px 2px; background: #F5F5F5;" |[[Gangrene]] can lead to [[sepsis]] which may manifest with [[dynamic precordium]], irregular [[heart rate]], irregular [[heart rhythm]], and [[heart murmurs]].
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| style="padding: 2px 2px; background: #E6E6FA; font-weight: bold" |[[Abdomen]]
|align="center" style="padding: 2px 2px; background: #E6E6FA; font-weight: bold" |[[Abdomen]]
| style="padding: 2px 2px; background: #F5F5F5;" |[[Patients]] usually has no pertinent findings.
| style="padding: 2px 2px; background: #F5F5F5;" |[[Patient]] usually has no pertinent findings.
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| rowspan="4" style="background: #E6E6FA;" |[[Skin]] / [[Extremities]]
| rowspan="4" align="center" style="background: #E6E6FA;" |[[Skin]] / [[Extremities]]
| style="padding: 2px 2px; background: #F5F5F5;" |[[Patients]] usually has no pertinent findings.
| style="padding: 2px 2px; background: #F5F5F5;" |[[Patient]] usually has no pertinent findings.
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| style="padding: 2px 2px; background: #F5F5F5;" |'''Dry Gangrene''' - The affected part is dry, shrunken, and dark black, resembling [[mummy|mummified]] flesh.
| style="padding: 2px 2px; background: #F5F5F5;" |'''Dry Gangrene''' - The affected part is shrunken, dry, and appears dark black.
<br>
[[Image:Extremities toe gangrene2.jpg|thumb|200px|center|[[Patient]] with a [[peripheral vascular disease]] that has led to an [[infarct]] of several [[toes]].<br> ('''Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA''')]][[Image:Extremities toe no gangrene2.jpg|thumb|200px|center|Same [[patient]]. Normal left [[foot]] for comparison. <br> ('''Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)''']]
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| style="padding: 2px 2px; background: #F5F5F5;" |'''Wet Gangrene''' - The affected part is [[edematous]], soft, putrid, rotten and dark.
| style="padding: 2px 2px; background: #F5F5F5;" |'''Wet Gangrene''' - The affected part is soft, dark, and [[edematous]] with putrid smell.
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[[Image:AUTOAMPUTATE1.JPG|thumb|200px|center|Person with [[diabetes]] who has severe [[infection]] and loss of [[toes]] <br> '''(Image courtesy of Charlie Goldberg, M.D., UCSD School of Medicine and VA Medical Center, San Diego, CA)''']]
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| style="padding: 2px 2px; background: #F5F5F5;" |'''[[Gas Gangrene]]'''- [[Gas gangrene]] can cause [[necrosis]] and gas production.
| style="padding: 2px 2px; background: #F5F5F5;" |'''[[Gas Gangrene]]'''- [[Gas gangrene]] can lead to [[necrosis]].
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| style="padding: 2px 2px; background: #E6E6FA; font-weight: bold" |[[Skin]] / [[Genitalia]]
|align="center" style="padding: 2px 2px; background: #E6E6FA; font-weight: bold" |[[Skin]] / [[Genitalia]]
| style="padding: 2px 2px; background: #F5F5F5;" |
| style="padding: 2px 2px; background: #F5F5F5;" |The [[genitals]] can be [[hyperemic]], [[necrotic]], and [[edematous]] with [[purulent]] [[suppuration]].<ref name="pmid29949811">{{cite journal| author=Chernyadyev SA, Ufimtseva MA, Vishnevskaya IF, Bochkarev YM, Ushakov AA, Beresneva TA | display-authors=etal| title=Fournier's Gangrene: Literature Review and Clinical Cases. | journal=Urol Int | year= 2018 | volume= 101 | issue= 1 | pages= 91-97 | pmid=29949811 | doi=10.1159/000490108 | pmc=6106138 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29949811  }} </ref>
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| style="padding: 2px 2px; background: #E6E6FA; font-weight: bold" |[[Skin]] / [[Neurologic]]
| align="center" style="padding: 2px 2px; background: #E6E6FA; font-weight: bold" |[[Neurologic]]
| style="padding: 2px 2px; background: #F5F5F5;" |
| style="padding: 2px 2px; background: #F5F5F5;" |[[Patients]] can be [[somnolent]], [[confused]], and not [[coherent]] due to [[sepsis]].
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[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Intensive care medicine]]
[[Category:Intensive care medicine]]
[[Category:Needs content]]
[[Category:Up to Date]]
[[Category:Needs overview]]
 
 
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Latest revision as of 16:13, 28 April 2022

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Edzel Lorraine Co, D.M.D., M.D.

Overview

Patients with gangrene may have varying presentations depending on the type of gangrene they have.

Physical Examination

Patients with gangrene may have varying presentations depending on the type of gangrene they have. Table 1 provides a summary of typical physical examination of a patient with gangrene.

Table 1. Summary of Physical Examination.
System Findings
General Appearance Patient with gangrene usually appears conscious, coherent, and in cardiorespiratory distress.
Vital Signs Patient is usually hypotensive and febrile. [1] [2]
HEENT Head can be normocephalic.
Eyes can be normal.
Ears can be normal.
Nose can be normal.
Throat can be normal.
Chest / Lungs Gangrene can lead to sepsis which may manifest with decreased chest expansion and decreased breath sounds.
Cardiovascular Gangrene can lead to sepsis which may manifest with dynamic precordium, irregular heart rate, irregular heart rhythm, and heart murmurs.
Abdomen Patient usually has no pertinent findings.
Skin / Extremities Patient usually has no pertinent findings.
Dry Gangrene - The affected part is shrunken, dry, and appears dark black.
Wet Gangrene - The affected part is soft, dark, and edematous with putrid smell.
Gas Gangrene- Gas gangrene can lead to necrosis.
Skin / Genitalia The genitals can be hyperemic, necrotic, and edematous with purulent suppuration.[3]
Neurologic Patients can be somnolent, confused, and not coherent due to sepsis.

References

  1. ↑ Chelsom J, Halstensen A, Haga T, Høiby EA (1994). "Necrotising fasciitis due to group A streptococci in western Norway: incidence and clinical features". Lancet. 344 (8930): 1111–5. doi:10.1016/s0140-6736(94)90629-7. PMID 7934492.
  2. ↑ Stevens DL, Tanner MH, Winship J, Swarts R, Ries KM, Schlievert PM; et al. (1989). "Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A." N Engl J Med. 321 (1): 1–7. doi:10.1056/NEJM198907063210101. PMID 2659990.
  3. ↑ Chernyadyev SA, Ufimtseva MA, Vishnevskaya IF, Bochkarev YM, Ushakov AA, Beresneva TA; et al. (2018). "Fournier's Gangrene: Literature Review and Clinical Cases". Urol Int. 101 (1): 91–97. doi:10.1159/000490108. PMC 6106138. PMID 29949811.
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