Mainstay of management includes:
-
Early administration of appropriate antibiotics
-
Source control which may include surgical debridement
-
Supportive management in intensive/high dependency care
Specific points:
-
Clindamycin +/- Linezolid (toxin suppression) + Broad spectrum (eg. Meropenem/Tazocin)
-
IVIG in confirmed Streptococcal TSS
-
May require massive fluid resuscitation
General ICU measures:
-
Monitor for ARDS and invasive ventilation as necessary
-
High dose vasopressor requirements
-
DVT and stress ulcer prophylaxis
-
Enteral nutrition and blood glucose control
The patient undergoes CT imaging of her ankle with inconclusive results. She is transferred to theatres for emergency exploration of her left calf, and undergoes a debridement and washout with minimal invasion. She spends a total of 3 weeks on intensive care requiring level 3 multi-organ support before being transferred to the medical ward to complete her recovery.
