Necrotizing Fasciitis and the Plush Doll

flesheatingdoll.jpg

After a bit of a delay, my article on Necrotizing Fasciitis was finally published the January issue of Critical Care Nursing Quarterly (Vol 28, No 1, pg. 80). Why NF? My sister suggested it one afternoon during a phone call that I initiated due to my lack of ability to come up with a paper topic for one of my grad school classes. Damn it is good to have a sister who is a nurse.

(Want more information on NF?)

Just days before I saw the article in print for the first time, I actually saw my first true case of NF. The patient presented to the ED a few days prior with a fishy story about being beaten. His story changed a few times and he had some significant bruising, but no major injuries. He was actually admitted to the MICU for some cardiac abnormalities that were found on exam. The ortho resident following him noted a cellulitis in his left arm that she had been following for a few days which was not improving.

The ortho team was called on day three of his admission because over a matter of two hours went from sitting up talking to being hemodynamically unstable, and for the most part crashed from sepsis. It was at this point I was made aware of the patient and his status. The resident had missed the diagnosis of NF. The only way to save him was to stabilize him, give him antibiotics, and most importantly perform radical debridement of his arm.

I met the surgeon in the OR. While the critical care team and anesthesia attempted to stabilize him on the table, I quickly asked Dr. B. if he would do a ‘finger test’ for me. He is your typical orthopaedic surgeon with all of the arrogance and height (he is 6’5”) of the stereotype. He didn’t know me very well and I was asking that he do something to his patient, on his turf, which he was unfamiliar with. At that point I didn’t care.

Through out my research for the article, all the papers addressed the difficulty in diagnosing NF. One old school procedure was to make a 2 cm incision over the suspect area, look for a ‘dishwater’ type of discharge and put a gloved finger into the incision. If a track existed on the facial plain (no resistance), NF should be highly suspected. I had known of no physician who had actually done a finger test. I was dying to see if it really worked.

Dr. B. looked at me as he sat down by the patient’s arm, in the middle of the chaos, and asked in a loud voice, “What was it you wanted me to do?”

Book research, seen in practice, seen in publication.

Damn that rocks.

If anyone wants to send me a birthday present, I would love one of these for my office.

Thanks Sue at Capsules and Nicholas at blogborygmi for the plush doll link.