0:00

I'm currently talking about head and neck emergencies that occur

0:05

very rarely in your experience as an emergency department

0:09

nor radiologist, but which are life threatening. Necrotizing

0:13

Fasciitis is a very dangerous infection that can occur after

0:18

dental infections, peri-tonsillar or pharyngeal abscesses,

0:22

oosteoradionecrosis , insect bites, previous surgery,

0:27

steroid neck injections, or skin popping by IV drug abusers.

0:32

What you see here is this very aggressive air forming bacteria

0:37

that is usually of a mixed flora that will aggressively

0:41

invade the fascia of the neck.

0:44

It will not respect the fascial boundaries of the

0:47

deep cervical fascia, be it the superficial,

0:49

middle or deep portions of the deep cervical fascia.

0:53

And what you see is just this gross area of necrosis

0:57

air in the neck bilaterally going through,

1:02

and the patient is just absolutely miserable.

1:06

And this has a very poor prognosis.

1:09

The risk factors for the patients, here we

1:12

have the risk factors of the infection,

1:13

but the patients that it occurs in include

1:16

those patients who are diabetics,

1:18

those patients who have severe atherosclerosis

1:20

with poor vascular supply to the neck anyway.

1:23

Alcoholics, chronic renal failure,

1:25

patients with malignancy who are unable

1:28

to mount an effective immune response,

1:30

the IV drug abusers who may be injecting in their

1:33

neck, or individuals in a postpartum situation.

1:36

So this is something that you want to recognize quickly.

1:41

Quite often they have to do surgery to remove

1:44

this necrotic tissue because, frankly,

1:47

the antibiotics don't help all that much without some surgical

1:50

intervention to decrease the overall

1:53

load of the inflammatory process.

Case 42 - Necrotizing Fasciitis: Summary

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