A 56-year-old woman with diabetes arrives with severe perineal pain. Triage acuity is ESI 1; T 102.7 F, BP 82/44 mm Hg, HR 138/min. Exam shows

Question

A 56-year-old woman with diabetes arrives with severe perineal pain. Triage acuity is ESI 1; T 102.7 F, BP 82/44 mm Hg, HR 138/min. Exam shows crepitus, dusky skin, and foul drainage involving the perineum. Lactate is 5.6 mmol/L. Which of the following is the most important immediate intervention?

Accepted Answer

Give broad-spectrum antibiotics and arrange emergent surgical debridement

Answer

Delay surgery until MRI confirms diagnosis

Answer

Treat with oral cephalexin and discharge

Answer

Apply warm compresses alone

Answer

Obtain outpatient dermatology review

Necrotizing infection management — ABEM Board MCQ

A 56-year-old woman with diabetes arrives with severe perineal pain. Triage acuity is ESI 1; T 102.7 F, BP 82/44 mm Hg, HR 138/min. Exam shows crepitus, dusky skin, and foul drainage involving the perineum. Lactate is 5.6 mmol/L. Which of the following is the most important immediate intervention?