Worst case EVER


That would be the worst case I’ve ever personally done.

Necrotizing fasciitis.

This is often caused by a group A streptococcus.

It attacks the muscles, fat, tissue and liquefies it into a rank gray brown ooze.

And it moves quickly, very quickly.

People die.

To get ahead of such a monster there is an incision and debridement.

There is an incision and the surgeon scrapes out the gray brown ooze until there is healthy muscle and tissue.

I’ve been in on lots of these cases.

Nothing to do but put peppermint on the mask, double mask if needed, and dive in.

This poor person had one of the worst cases I’ve ever seen.

The entire limb was affected. The surgeon kept cutting more and more and more.

Peppermint was not adequate for smell containment.

This smell required benzoin.

After hour 2 I informed the surgeon that I would be putting in a foley catheter at the end of the case as the limb was now half flayed open and I thought they would need it to be able to watch the I&Os carefully.

This was when I quietly began making arrangements for a higher level of care than Med-Surg. Not that they aren’t capable but this was rapidly becoming beyond their capacity.

After hour 3 I informed the surgeon that I had saved an ICU bed for the patient. This was when we were at a major joint and headed south.

He agreed absently, intent on getting all the dead tissue out.

After hour 4 he began to do the final irrigation of what had been this limb and asked me to block off time 24 hours in the future for a bring back. To do more debridement.

I met the PA’s eyes over our masks. We didn’t think the patient would survive that long.


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