Necrotising fasciitis

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Question 1 of 3

1. Question
Which of the following statements is true regarding his risk of having necrotising fasciitis?
- This cannot be necrotizing fasciitis because the pain score is only 4/10. Necrotizing fasciitis always causes excruciating pain
- This is unlikely to be necrotising fasciitis because >90% of patients have signs of sepsis at presentation (fever, tachycardia and hypotension)
- The majority of patients (>90%) have haemorrhagic bullae or skin necrosis at presentation
- The majority of patients (>90%) will have been unwell for several days prior to presentation to hospital with necrotizing fasciitis
- The majority of patients (>90%) will have comorbidities such as diabetes mellitus, malignancy, intravenous drug abuse or are on immunosuppressive therapy
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Question 2 of 3

2. Question
His blood results are as follows.

Haemoglobin 11.7, White cell count 17.4, Platelets 420, Sodium 130, Potassium 4.1, Urea 9.3, Creatinine 157, CRP 205, Glucose 15.7

Which of his blood test results would NOT be predictive of necrotizing fasciitis when used as part of the LRINEC score?
- Haemoglobin 11.7 mg/dL
- Serum Sodium 130
- CRP 205
- Glucose 15.7
- Urea 9.3
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Question 3 of 3

3. Question
Which of the following is the most appropriate management for this patient?
- Admit for intravenous antibiotics, intravenous fluids and monitor urine output
- Admit for analgesia and observation, with plan to escalate to Surgical Consultant if the patient develops signs of sepsis or spreading erythema
- Admit for US scan and if this is normal continue to observe for clinical deterioration
- Discuss with on call Plastics Consultant for immediate review /surgical exploration
- Admit under Medicine/infectious diseases for CT imaging if develops sepsis or clinical deterioration
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Necrotising fasciitis

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