Case of cervical necrotizing fasciitis successfully treated by rapid response system activation

Abstract

Response teams, via the rapid response system (RRS), are activated when a patient's condition deteriorates; respiratory, neurological, or cardiac diseases are precursors to unexpected in-hospital cardiac arrest or death. In December 2019, our hospital introduced the RRS to reduce serious adverse events. Herein, we report a case where RRS was initiated twice for a patient who developed septic shock due to cervical necrotizing fasciitis and non-occlusive mesenteric ischemia (NOMI) after the septic shock. In August 2021, a male in his 70 s developed facial swelling, difficulty opening his mouth, and difficulty with oral intake. We observed necrotic skin on the face, soft tissue swelling in the neck, and hypotension. The RRS was initiated, and the patient was immediately admitted to the intensive care unit (ICU) where he was diagnosed with septic shock and necrotizing fasciitis of the neck. The patient underwent surgical necrotic lesion debridement and incisional drainage under general anesthesia. After weaning from shock, owing to his hypotensive and hemorrhagic status, the RRS was requested again. The patient was re-admitted to the ICU and diagnosed with NOMI. His general condition improved, and he was discharged on day 47.