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Immediate priorities
Time critical stabilization
Escalate to resuscitation bay for suspected necrotizing soft tissue infection
Disproportionate pain
Rapidly progressive perineal or genital infection
If shock or altered mental status, initiate sepsis bundle within 1 hour
Crystalloid 30 mL/kg for hypotension or lactate 4 mmol/L or higher
Broad spectrum antibiotics immediately after cultures when feasible
If airway compromise or severe agitation, initiate airway management
Prepare for rapid sequence intubation
Post intubation ventilation targets PaCO2 35-45 mmHg unless contraindicated
If persistent hypotension after fluids, initiate vasopressor
Norepinephrine first line, Class I recommendation in sepsis guidelines
MAP 65 mmHg target
Activation and consults
Surgical team activation
Immediate consultation for operative debridement
General surgery
Urology for genital involvement
If extensive tissue loss anticipated, plastics early
Coverage planning
Staged reconstruction
If suspected anorectal source, colorectal surgery
Perianal abscess or fistula source control
Monitoring and access
Hemodynamic monitoring
Two large bore IV lines
Consider intraosseous if access delay
Early central venous access if vasopressors anticipated
Arterial line if vasopressors or labile blood pressure
MAP 65 mmHg goal
Lactate clearance trend
Urine output monitoring
Foley catheter unless urethral injury suspected
Target 0.5 mL/kg/hour
Key concepts
Core diagnosis logic
Fournier gangrene is necrotizing fasciitis of perineum and genital region
Polymicrobial infection common
Surgical source control is definitive therapy
Antibiotics without debridement associated with high mortality
Earlier debridement associated with improved outcomes
Multiple staged debridements common
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.