Medical History A 50-year-old man, cirrhotic (CHILD C12) and diabetic, was hospitalized due to decompensation of hepatorenal syndrome and was treated with hemodialysis using a double lumen catheter in the left jugular vein. After 20 days, he presented painful crackling edema in the right shoulder blade, right forearm and his left calf, which evolved rapidly with purple spots, worsening of the medical state, leukocytosis with left shift, elevation of CRP and shock. Photo of the posteromedial region of the left leg.Radiograph of the right forearm in profile (A) and anteroposterior (B) views.Non-contrast computed tomography of the left leg axial (A) and sagittal (B) planes. Question:Considering the hypothesis of necrotizing fasciitis (NF) and the imaging exams, which alternative below describes the best medical conduct? Hemodynamic support, start antibiotic therapy with meropenem and vancomycin, and perform surgical debridement of the lesions urgently. Hemodynamic support, start antibiotic therapy with meropenem and vancomycin, and request magnetic resonance to guide surgical approach. Hemodynamic support, start antibiotic therapy with meropenem, and perform surgical debridement of the lesions. Hemodynamic support, start antibiotic therapy with vancomycin, and request magnetic resonance to guide surgical approach. Test Question (Medical residency - PUC-PR 2012) About the Necrotizing Fasciites, the alternatives bellow are correct, EXCEPT: Fournier Gangrene is a type of necrotizing fasciitis There’s extensive necrosis of the superficial fascia Usually, there’s no myonecrosis The skin is primarily compromised There’s moderate or severe systemic toxic reaction Time is Up! Time's up
