Case 1

A 52 year old man is referred to ED by his GP with cellulitis to his left chest wall and signs of sepsis. He reports a 2 day history of pain and tenderness to the left chest wall with several episodes of vomiting and pyrexia.

On assessment his chest wall is pictured opposite. There is a large area of induration and erythema to his lateral chest wall with areas of necrosis. He is very tender to touch and there is palpable surgical emphysema underlying the erythema.

His observations are as follows;

Temp 39, RR20, HR 130, BP 120/60, 99% RA

His lactate is 5.8