The EM Educator Series: Fournier Gangrene – Simple, raging cellulitis

Author: Alex Koyfman, MD (@EMHighAK) // Reviewed by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome back to the EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

Case 1:

A 35-year-old male with no past medical history presents with severe rectal pain and inability to sit still on stretcher despite pain medication. He is tachycardic and appears in severe pain.

Case 2:

A 65-year-old female with history of diabetes and obesity presents with altered mental status.  She is febrile, tachycardic, and hypotensive. On examination you find redness in the perineal region that tracks up the anterior abdominal wall.

Considerations:

• What are the major risk factors for Fournier gangrene?
• How can patients present?
• What laboratory testing may be helpful, and what risk scores are available?
• What is the utility of imaging, including ultrasound?
• What are the ED management priorities?
• What are major pitfalls with Fournier gangrene?

Suggested Resources: 

• #FOAMed
  • emDOCs Fournier Gangrene
  • emDOCS Misdiagnosing and Mismanaging
  • IBCC – NSTI
  • Wik EM
• Journal Articles
  • JEM – Fournier Gangrene
  • JEM – NSTI Pearls and Pitfalls