A 52-year-old man with diabetes presents with severe pain in his thigh after minor trauma. Temperature is 38.9 C, HR 132, BP 94/56 mmHg, CRP 310 mg/L

Question

A 52-year-old man with diabetes presents with severe pain in his thigh after minor trauma. Temperature is 38.9 C, HR 132, BP 94/56 mmHg, CRP 310 mg/L and sodium 128 mmol/L. The skin is dusky with small bullae and pain extends beyond erythema. What is the most appropriate next step in management?

Accepted Answer

Urgent surgical exploration with broad-spectrum intravenous antibiotics

Answer

Request MRI before surgical referral

Answer

Mark the erythema and review after 24 hours of oral antibiotics

Answer

Treat as uncomplicated cellulitis with flucloxacillin alone

Answer

Aspirate the bulla and await culture

Necrotising fasciitis — SCE Acute Medicine MCQ

A 52-year-old man with diabetes presents with severe pain in his thigh after minor trauma. Temperature is 38.9 C, HR 132, BP 94/56 mmHg, CRP 310 mg/L and sodium 128 mmol/L. The skin is dusky with small bullae and pain extends beyond erythema. What is the most appropriate next step in management?