Hi all!
Giving an injection which might entrain gas gangrene organisms into muscle
which is temporarily or permanently ischaemic is a far more dangerous
procedure than similarly risking introducing the same orgnaisms into sub-cut
tissues. Clostridial cellulitis does not have anything like the lethal
quality of clostridial myositis (which is gas gangrene). A few Clostridia
in the blood stream of an oxygenated patient would probably not survive
either but even one or two organisms in what would really be an anaerobic
culture medium might flourish. I have not had any time for search on this,
but I seem to recall that the caveat about IM adrenaline comes from vascular
surgical experience in patients who already have compromised circulation in
the lower limb muscles.
Again, from memory, I imagine there is a greater risk of significant
Clostridial skin contamination "below the waist". I agree with you, Rowley,
that we jolly well ought to be able to make sure we don't entrain
contaminants when we give an injection but I suspect we quite often do and
that it is the tissues defences which save the patient from trouble (and
us). In a muscle which is made ischaemic by localised vasospasm the defence
against anerobes may be temporarily down.
I hope that makes sense. IM injections of adrenaline may make sense in
occasional emergencies but they do have a special problem which has
occasionally cause potentially lethal complication.
Jonathan Marrow
----- Original Message -----
From: "Rowley Cottingham" <[log in to unmask]>
To: <[log in to unmask]>
Cc: <[log in to unmask]>
Sent: Sunday, May 14, 2000 06:11
Subject: Re: intramuscular adrenaline
> No. If it did happen, though, which would you rather explain - a bit of
dead muscle or a dead
> patient. I can't envisage a scenario where you would be injecting someone
with such a dirty
> needle that it was full of clostridium bacteria - and if it was the
problem would be just as bad
> injected subcutaneously and much worse if you injected it intravenously.
>
> Best wishes,
>
>
> Rowley Cottingham
>
> [log in to unmask]
>
>
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