From the Guidelines
The initial workup for a patient with Diffuse Intramuscular Septic (DIMS) symptoms should include a comprehensive clinical assessment, laboratory tests, and imaging studies. Begin with a thorough history and physical examination, focusing on potential sources of infection and systemic inflammatory response signs. Laboratory tests should include complete blood count with differential, comprehensive metabolic panel, C-reactive protein, erythrocyte sedimentation rate, creatine kinase, and blood cultures (at least two sets from different sites) 1. Obtain muscle enzyme tests including aldolase, lactate dehydrogenase, and myoglobin levels. Imaging should start with plain radiographs of affected areas, followed by MRI which is the gold standard for identifying muscle inflammation and abscess formation. CT scanning may be used if MRI is unavailable. Consider ultrasound for guided aspiration of fluid collections for culture and sensitivity testing. Additional tests may include urinalysis to check for myoglobinuria, coagulation studies, and specific serologies based on suspected pathogens. This comprehensive approach is necessary because DIMS can rapidly progress to severe sepsis, with potential complications including compartment syndrome and multiorgan failure, requiring prompt diagnosis and treatment to prevent significant morbidity and mortality.
Some key points to consider in the workup include:
- Identifying the source of infection and implementing source control as soon as possible 1
- Using fluid challenge technique to guide fluid administration and achieve hemodynamic improvement 1
- Considering the use of crystalloids as the initial fluid of choice and avoiding the use of hydroxyethyl starches for fluid resuscitation 1
- Using norepinephrine as the first-choice vasopressor and considering the addition of vasopressin or epinephrine as needed 1
It's also important to note that the workup and management of DIMS may involve a multidisciplinary approach, including consultation with specialists such as infectious disease experts, surgeons, and critical care specialists. The goal of treatment is to promptly identify and manage the source of infection, stabilize the patient, and prevent complications. By taking a comprehensive and multidisciplinary approach, healthcare providers can improve outcomes and reduce morbidity and mortality in patients with DIMS.
From the Research
Initial Workup for DIMS
The initial workup for a patient with Diffuse Intramuscular Septic (DIMS) symptoms is not directly addressed in the provided studies. However, we can look at the general approach to diagnosing and managing similar conditions:
- A thorough history and physical examination are essential in identifying the underlying cause of symptoms 2.
- Laboratory tests, such as complete blood count, blood cultures, and imaging studies, may be necessary to confirm the diagnosis and guide treatment 3.
- A detailed history and physical examination can provide clues that guide a logical approach to the evaluation of symptoms 4.
Diagnostic Approach
A diagnostic approach to DIMS may involve:
- Identifying underlying conditions that may be contributing to the symptoms, such as infections or inflammatory disorders 2.
- Conducting laboratory tests to rule out other conditions that may be causing the symptoms, such as deep venous thrombosis or disseminated intravascular coagulation 5, 6.
- Using imaging studies to visualize the affected area and guide treatment 3.
Treatment
Treatment for DIMS will depend on the underlying cause of the symptoms. It may involve:
- Antibiotics or other medications to treat underlying infections or inflammatory disorders 2.
- Supportive care, such as pain management and wound care, to manage symptoms and promote healing 3.
- Surgery or other interventions may be necessary in some cases to treat underlying conditions or manage complications 6.