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Recognizing Fournier's Gangrene in the Emergency Department

Gadler, Tracie, DNP, APRN, FNP-C, RNFA; Huey, Sally, DNP, APRN, FNP-BC; Hunt, Kelly, MSN, APRN, FNP

Section Editor(s): Martinez, Nicole MSN, RN, FNP-BC, ENP-C, PHN; Column Editor

Advanced Emergency Nursing Journal: January/March 2019 - Volume 41 - Issue 1 - p 33–38
doi: 10.1097/TME.0000000000000221
DERMATOLOGY DILEMMAS
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Fournier's gangrene is a rare disease with a significant mortality rate. The potentially fatal disease stems from both aerobic and anaerobic bacteria and primarily occurs in men. The majority of Fournier's gangrene cases are idiopathic or derived from perineal and genital skin infections. Comorbid risk factors include diabetes mellitus, alcohol misuse, and immunosuppression (Benjelloun et al., 2013). The infection initially presents as a cellulitis in the perineum or perianal area. As Fournier's gangrene progresses, the infected tissue becomes swollen, significantly painful, and necrotic. The progression of infection can lead to systemic symptoms, sepsis, and death. Early intervention is a key component in the treatment plan for Fournier's gangrene. The primary intervention is surgical debridement of the necrotic tissue. If an abscess is present, incision and drainage are indicated. In addition to surgical debridement, the administration of broad-spectrum antibiotics and hemodynamic stabilization are required (Cottrill, 2013). Complications after treatment include chronic pain, sexual dysfunction, decreased sensation of the penile skin, and scarring (Benjelloun et al., 2013).

Georgetown University, Washington, District of Columbia.

Corresponding Author: Tracie Gadler, DNP, APRN, FNP-C, RNFA, Georgetown University, 3700 Reservoir Rd, Washington, DC (traciegadler@gmail.com).

Disclosure: The authors report no conflicts of interest.

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