Necrotizing soft tissue infections Quiz: Ace Your Exams
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A 58-year-old woman presents to the emergency department for evaluation of 2 days of worsening left leg pain, fevers, and fatigue. The patient has a past medical history of IV drug use and reports that she recently injected heroin into her left foot. Temperature is 38°C (100.4°F), blood pressure is 132/60 mmHg, pulse is 104/min, respiratory rate is 18/min, and oxygen saturation is 97% on room air. The patient appears uncomfortable. Examination of the left lower extremity reveals erythema over the dorsal foot, induration, and moderate tenderness to palpation. No crepitus is palpated. The patient is started on IV fluids and broad-spectrum antibiotics. Laboratory findings are shown below. CT imaging demonstrates evidence of increased attenuation and stranding of the subcutaneous fat, as well as edema and fluid tracking along the superficial and deep fascia of the calf. Which of the following is the best next step in management?
| Laboratory value | Result |
| Serum chemistry | |
| Sodium | 129 mEq/L |
| Potassium | 4.5 mEq/L |
| Chloride | 97 mEq/L |
| Creatinine | 1.8 mg/dL |
| HCO3 | 18 mEq/L |
| Glucose | 343 mg/dL |
| BUN | 25 |
| CBC | |
| Hemoglobin | 11.5 g/dL |
| Leukocyte count | 18,100 /mm3 |
| Platelet count | 225,000/mm3 |
| Lactic acid | 3.6 |
| CRP | 25 mg/dL |
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