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Dirty White Coat

The Pitt

Necrotizing soft tissue infections demand immediate recognition and aggressive treatment to prevent devastating outcomes and death. Dr. Mellick reviews critical diagnostic features, treatment protocols, and exam-relevant information about these life-threatening conditions through a series of board-style questions.

• Necrotizing infections in IV drug users present with severe pain, woody edema, and require immediate surgical exploration
• Hemorrhagic bullae and crepitus are "hard findings" strongly suggesting necrotizing fasciitis
• Clindamycin plus broad spectrum antibiotics are essential to reduce toxin production and address polymicrobial nature
• CT scan offers the best combination of sensitivity and availability for diagnosing necrotizing infections
• Specific pathogens like Vibrio vulnificus should be considered in patients with exposure to coastal waters
• Risk factors include immunocompromise, diabetes, cirrhosis, and injection drug use
• Early surgical consultation and intervention are more important than waiting for imaging results

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