{
  "schema_version": 1,
  "kind": "condition",
  "id": "gangrene-emergency-referral",
  "name": "Gangrene and Diabetic Foot (Emergency Referral)",
  "category": "chronic",
  "sources": "ADA Standards of Care in Diabetes 2024 · NICE Guideline NG19: Diabetic foot problems 2019 · Gangrene - StatPearls (NCBI Bookshelf NBK560552) - https://www.ncbi.nlm.nih.gov/books/NBK560552/: \"Gas gangrene, typically caused by Clostridium species, is a life-threatening necrotizing infection requiring urgent intervention.\", \"Management includes prompt surgical debridement or amputation, broad-spectrum antibiotics, and, in some cases, intravenous immunoglobulin to bind and neutralize toxins.\" and \"Surgery within 24 hours of admission significantly improves survival.\"",
  "review_status": "reviewed",
  "verified_against": "Gangrene - StatPearls (NCBI Bookshelf NBK560552) - https://www.ncbi.nlm.nih.gov/books/NBK560552/: \"Gas gangrene, typically caused by Clostridium species, is a life-threatening necrotizing infection requiring urgent intervention.\", \"Management includes prompt surgical debridement or amputation, broad-spectrum antibiotics, and, in some cases, intravenous immunoglobulin to bind and neutralize toxins.\" and \"Surgery within 24 hours of admission significantly improves survival.\"",
  "verified_date": "2026-08",
  "treatments": [
    {
      "id": 769,
      "generic": "No drug therapy in primary care (Emergency Referral)",
      "line": 1,
      "is_adjunct": false,
      "form": null,
      "strength_mg": null,
      "adult_dose": "Immediate emergency transfer to a hospital with vascular surgery and diabetic foot capabilities for urgent debridement, revascularization assessment, deep tissue culture, and intravenous broad-spectrum antibiotic therapy.",
      "adult_duration": "Immediate emergency transfer",
      "dose_source": "Gangrene - StatPearls (NCBI Bookshelf NBK560552) - https://www.ncbi.nlm.nih.gov/books/NBK560552/: \"Gas gangrene, typically caused by Clostridium species, is a life-threatening necrotizing infection requiring urgent intervention.\", \"Management includes prompt surgical debridement or amputation, broad-spectrum antibiotics, and, in some cases, intravenous immunoglobulin to bind and neutralize toxins.\" and \"Surgery within 24 hours of admission significantly improves survival.\"",
      "rationale": "Diabetic foot gangrene is a time-critical, limb- and life-threatening emergency requiring emergency surgical intervention and parenteral antibiotics rather than primary care management.",
      "cautions": [
        "TIME-CRITICAL SURGICAL EMERGENCY: Wet gangrene, gas gangrene, systemic sepsis, or ascending erythema/crepitus require emergency hospital transport within hours.",
        "Do NOT delay emergency transfer for outpatient oral antibiotic trials, topical antiseptics, or wound dressings in primary care.",
        "Assess peripheral arterial pulses (dorsalis pedis, posterior tibial), check for loss of protective sensation, and monitor for systemic inflammatory response syndrome (fever, hypotension, tachycardia)."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Pediatric gangrene (rare, e.g. meningococcemia, purpura fulminans, or severe vascular ischemia) requires immediate emergency transfer to a pediatric intensive care and pediatric surgical center.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [],
      "condition_id": "gangrene-emergency-referral"
    }
  ]
}