33/34: Management of Soft Tissue Infection - Dayton

Question 1

cellulitis =

Answer 1

skin and connective tissue infection and inflammation w/o necrtotic or purulent collections

Question 2

abscess =

Answer 2

deep tissue infection w/ necrotic tissue and/or purulent collections

involving tissue compartments, joints, tendon sheaths or deep spaces

Question 3

s/s cellulitis

Answer 3

erythema, edema

pain, fever, chills, malaise

Question 4

s/s abscess

Answer 4

erythema, edema

fluctuance, purulence, necrosis

pain, fever, chills, malaise

Question 5

rapid wide spread necrosis with sever systemic symptoms

Answer 5

necrotizing fasciitis

Question 6

common organisms:

cellulitis

abscess and post op

necrotising fasciitis

puncture wound

diabetic infection

Answer 6

• cellulitis
  
  • strep group A, staph aureus
• abscess and post op
  
  • staph aureus
• necrotising fasciitis
  
  • type 1 = anaerobic, non group A strep
  • type 2 = group A strep w/ or w/o staph
• puncture wound
  
  • staph aureus, p. aeruginosa (osteomyelitis)
• diabetic infection
  
  • staph. aureus

Question 7

what is fever?

Answer 7

greater than 100.5 F

immunocompromised may not mount a febrile response

Question 8

what is a high WBC

Answer 8

greater than 12 K = leukocytosis

left shift = immature WBC

Question 9

s/s lymphatic involvement

Answer 9

• inflammatory rxn in lymph channels
• eryhtematous lymphatic streaking
• palpable or painful lymph nodes

Question 10

SIRS sytemic inflammatory response syndrome =

Answer 10

• temp less than 96.8 or greater than 100.5
• HR greater than 90
• Respirations greater than 20
• PaCO2 less than 32
• WBC less than 4 K or greater than 12 K

Question 11

sepsis =

severe sepsis =

septic shock =

Answer 11

sepsis = SIRS and documented infection

severe sepsis = sepsis and organ dysfunction

septic shock = sepsis and acute persistent circulatory failure

Question 12

s/s organ dysfunction

Answer 12

• altered mental status
• edema
• cardiac index greater than 3.5
• acute oliguria
• arterial hypoxemia
• high CR
• INR greater than 1.5
• platelet count less than 100X10⁹
• lactate greater than 1

Question 13

treatment cellulitis

Answer 13

empiric antibiotics

Question 14

treatment abscess or necrosis

Answer 14

incision and drainage are priority!

Question 15

culture technique

Answer 15

• tissue is better than pus
• avoid skin contact to limit confusion of skin flora and pathogens

Question 16

cellulitis tx

community acquired -

MRSA suspected -

nosocomial -

Answer 16

community acquired: nafcillin, cefazolin, clindamycin

MRSA: TMP/SMZ, clindamycine

Nosocomial: vancomycin

Question 17

diabetic foot infection tx

mild -

moderate -

Answer 17

mild: dixloxacillin, cephalexin, clindamycin, facillin, cefazolin
moderate: ampicillin/sublactam - clindamycin + levaquin

Question 18

animal and human bites

Answer 18

non allergic = ampicillin/sulbactam

PCN allergy = clindamycin + levaquin

Question 19

tx paronychia

Answer 19

• incision and drainage
• antibiotics rarely needed if not immunocompromised

Question 20

criteria for hospital admission

Answer 20

• profound clinical symptoms (sepsis)
• one or more contributing disease states
• antibiotics requiring inpatient monitoring
• failure of out patient therapy
• suspicion of absces requiring I&D

Question 21

most important tx abscess

Answer 21

1. I&D/culture

then …

1. empiric antibiotics
2. medical evaluation
3. vascualr and other testing
4. directed antibiotics afeter cultures are available
5. open wound management
6. delayed closure or reconstruction

Question 22

puncture wound tx is based on zone of involvement

Answer 22

• always get an x-ray
• zone 1 = high risk
• zone 2 = low risk
• zone 3 = mod risk