SURGICAL SEPSIS · MEMBERSHIP SURGERY

Necrotising fasciitis / Fournier's — 55M diabetic

12 decision points ~24 min Difficulty 5/5 Membership

Setting

You are the surgical registrar on-call at Korle Bu. Theatre + anaesthesia are activated on request; ICU has capacity; hyperbaric oxygen is not available; broad antibiotics + blood-bank on standby.

Patient

Mr B, a 55-year-old diabetic mason (HbA1c 11.2%), presents with 48 hours of increasing pain and swelling in the perineum after minor perineal excoriation. He is toxic-looking: BP 92/54, HR 128, temp 39.4, RR 26, GCS 13. Perineum, scrotum and lower abdomen show mottled erythema, dusky patches, crepitus, foul-smelling sero-sanguineous discharge, and pain out of proportion to examination findings.

Reference stack

Bailey & Love 28e Ch 4 · Sabiston 21e Ch 15 · WSES 2022 skin and soft tissue infections · IDSA 2014 SSTI · LRINEC (Wong 2004)

Start cascade →

You'll be asked to decide what happens next at each step. There's no timer — take your time. The correct answer + evidence-anchored rationale is revealed after each choice.