1.13 Epidural Abscess

Question 1

Risk factors for developing

Answer 1

1. Immunocomp
   - Steroid, DM, HIV, Cancer, Chemo /RTX, ETOH IVDU, Preg
2. Primary nferction
   Soft tissue, presence ivc
   w/ spread to spinal column
   exacerbated in immunocomp

3. Central neuraxial block
multiple attempts
poor aseptic technique
coagulopathy (haematoma = happy bacteria)
cethter >4d
Cather dressing - moist skin
break integrity of drug deliver

4. Breach spinal column integrity 
surgery
intsrumentation
trauma
vert collapse OA / OPorosis

Question 2

Investigations

Answer 2

Exam

Ix

Radiology

Question 3

Exam

Answer 3

Inpection site
edvidence subcut infection ?

Full neuro exasm
warning sx
deficit reflexs incontinence meningism

Question 4

Ix

Answer 4

WCC CRP
ESR

Cultures
Identify primary site
CXR MC+S wound

Common organism -
S.Aur, Strep Gr -

Less - mycobact fungal parasiotic

Question 5

Radiology

Answer 5

Spine radiography
rarely dx

Myelography
invasive / spread

Ct Spine
prev gold standard

MRI spine
whole w/ gad - gold standard

Question 6

Management

Answer 6

Removal catheter
tip for cx

Prolong iv abx
guide micro adjust culutres
IV 4/52
convert to po futher 8/52

regular monitor temp site fxn neurology + markers

Question 7

Non surgical mx

Answer 7

Crtieria 
minor neuro
on abx
poor candidate comorbs
abscess so large would destroy spinal structure

Question 8

Surigcal

Answer 8

Early open decomp

rapid onset neuro deterioration

extensive / loculated

failed medical tx

During surgery
debride
pus swab mc+s 
aafb
tissue histology