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Spinal epidural abscess — RCPSC EM MCQ

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HardInfectious disease emergenciesSpinal epidural abscessRCPSC EM

A patient with diabetes has rapidly progressive thigh pain out of proportion to examination, expanding erythema, fever and new haemorrhagic bullae. Lactate is elevated but the LRINEC score is low. What is the most appropriate next action?

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Correct answer: C — Start broad IV antimicrobials and obtain immediate surgical assessment

The best answer is “Start broad IV antimicrobials and obtain immediate surgical assessment”. Clinical concern for necrotizing soft-tissue infection overrides a low or equivocal LRINEC score. Early broad antimicrobial therapy and urgent surgical assessment for exploration and debridement are time-critical; imaging must not postpone source control in a rapidly progressive presentation. Ordinary cellulitis therapy or bedside drainage alone misses the deep fascial emergency.

Reference: Emergency Care BC: LRINEC Score for Suspected Necrotizing Soft Tissue Infections: https://emergencycarebc.ca/clinical_resource/clinical-summary/the-lrinec-score-for-suspected-necrotizing-soft-tissue-infections/