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Necrotizing soft tissue infection — ABEM Board MCQ

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HardMusculoskeletal/Orthopedic emergenciesNecrotizing soft tissue infectionABEM Board

A 49-year-old man arrives with rapidly worsening thigh pain after a minor scrape. Triage acuity is ESI 2; T 103.2 F, BP 88/50 mm Hg, HR 136/min. The thigh is swollen with dusky skin, bullae, crepitus, and pain beyond visible erythema. Sodium is 126 mEq/L. Which of the following is the most likely diagnosis?

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Correct answer: E — Necrotizing fasciitis

Pain out of proportion, shock, bullae, crepitus, and rapid progression indicate necrotizing soft tissue infection requiring surgical debridement.

Reference: IDSA skin and soft tissue infection guideline