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Necrotising fasciitis with septic shock — SCE Acute Medicine MCQ

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HardInfectious diseasesNecrotising fasciitis with septic shockSCE Acute Medicine

A 61-year-old man with diabetes presents with severe thigh pain 24 hours after a minor graze. He is febrile, confused and hypotensive; the thigh is swollen with dusky skin and crepitus. CRP is 310 mg/L, sodium is 126 mmol/L and lactate is 6.0 mmol/L. What is the most appropriate next step in management?

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Correct answer: D — Urgent surgical exploration with broad-spectrum antibiotics and resuscitation

Necrotising fasciitis is a surgical emergency; severe pain, shock, crepitus, hyponatraemia and high lactate mandate immediate senior surgical involvement, broad-spectrum antibiotics and resuscitation. Imaging may help if it does not delay theatre, but clinical instability should drive action. Antibiotics alone are inadequate without source control.

Reference: NICE CKS necrotising fasciitis; Surgical Infection Society guidance