How should I initiate management for a patient with suspected wet gangrene before specialist referral?

Initial management of suspected wet gangrene before specialist referral includes:

• Urgent assessment and referral: Recognise wet gangrene as a medical emergency requiring prompt specialist input, ideally to a multidisciplinary foot care service or vascular surgery team.
• Start empirical intravenous antibiotics immediately: Begin broad-spectrum antibiotics covering likely pathogens, including anaerobes and gram-negative bacteria, after obtaining appropriate microbiological samples (deep tissue or bone samples if possible) to guide therapy.
• Take microbiological samples before antibiotics if feasible: Obtain deep tissue or bone samples from the wound base for culture to tailor antibiotic treatment later.
• Provide supportive care: Ensure adequate analgesia, fluid resuscitation if needed, and monitor for systemic signs of sepsis.
• Do not delay referral for imaging: Arrange urgent imaging (e.g., X-ray, MRI) to assess the extent of infection and rule out osteomyelitis or necrotising fasciitis.
• Avoid inappropriate wound care: Do not use Eusol, gauze, or mercuric antiseptics; use appropriate interactive dressings if wound care is initiated.
• Prepare for possible surgical intervention: Early surgical debridement or amputation may be necessary; therefore, stabilise the patient and expedite specialist review.

These steps aim to control infection, prevent systemic deterioration, and facilitate timely specialist management of wet gangrene.

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