37: Infectious Disease - Smith Flashcards
clinical s/s of infection
- Fever, Chills, Night Sweats
- Lump
- Red streaks
- Duration of symptoms
- Prior therapy
- Medical history
- Allergies
- Social history
- Pets
PE infection
- Overall patient appearance (appear sick, lethargic, diaphoretic, disheveled)
- Temperature
- Cellulitis
- Lymphadenopathy
- Lymphangitis
- Open lesions
- Drainage/ Fluctuance/ Crepitus
define cellulitis and its most common pathogen
Inflammation of the skin and connective tissues - Streptococcus (usually a gram + organism)
five cardinal signs of celsus ***
Rubor (Redness) Tumor (Edema) Dolor (Pain) Calor (Heat) Functio Lasea (Loss of function)
“red, hot, painful, swollen “
Red streaking caused by inflammation of the lymphatic channels draining the of infection
lymphangitis
what do you have to record about open lesions? ***
depth
size
shape
tissue or debris within lesion
how do you describe drainage?
How much
Type
Color
Odor
Fluid beneath surface of skin which may be an abscess or hematoma
fluctuance (like palpating a water balloon)
yellow/gold drainage
staphAUREUS
white drainage
staphEPI
brown dishwater drainage
anaerobic bacteria life-threatening severe
crepitus w/ signs and symptoms of infection =
surgical emergency
- feeling of crepitus is created by subcutaneous air or gas
what is a normal WBC
under 11,000
left shift WBC
fighting off infection and putting immature into circulation
do platelets increase or decrease with infection
increase
describe ESR erythrocyte sedimentation rate
- Measures the distance (mm) that a column of erythrocytes falls in one hour
- Erythrocytes fall in a rouleaux formation in the presence of acute phase reactants
- INCREASED in infection, malignancy or inflammation
- Used to monitor therapy
- normal sed rate is 15 or less male, 20 or less female
more sensitive but not specific in comparison to sed rate
CRP c-reative prtn
- acute phase reactant
infection does what to blood glucose
increase
where should a wound culture be taken from first?
- Wound culture taken from the deepest part of the wound (anaerobic culture first)
- Culture should be taken prior to antibiotic therapy
3 types of blood cultures
Transient Bacteremia - Happens on daily basis
Intermittent
Bacteremia - Septic foci seeding the blood
Continuous Bacteremia - Bacterial endocarditis
*** hospitalization guidelines
- High fever > 101º F
- High WBC > 13,000
- Systemic infection or sepsis
- Failure to respond to outpatient therapy
- Organism only susceptible to parenteral agent
- Debridement requiring general anesthesia
- Systemic disease
infected ingrown nail
paronychia
- nail spicule must come out
- five cardinal signs of infection along nail with purulent drainage
interdigital maceration and pruritus, with possible cellulitis
gram negative interspace infection
wood’s lamp (UV) reveals…
green fluorescence = gram neg pseudomonas
coral red = gram pos = Erythrasma (Corynebacterium)
*** coral red wood’s lamp UV
erythrasma
gram pos corynebacterium infection
describe the pathophysiology of osteomyelitis
- Destruction of trabeculae and bone matrix at site of infection resulting in radiolucency radiographically
- Spreads from original site through medullary bone and haversian canals of cortical bone
- Ischemic necrosis of bone
sequestrum in osteomyelitis
As infection progresses within the bone, segments of necrotic bone are isolated from viable bone - Sequestrum (Dense sclerosis)
involucrum in osteomyelitis
The outer cortex of bone violated with elevation of periosteum and stimulation of new bone to wall off infection - Involucrum
cloaca in osteomyelitis
New bone formation violated releasing infection into soft tissue - Cloaca
Most common cause of acute OM in body, but rare in foot
hematogenous osteomyelitis
*** hematogenous osteomyelitis in ... neonates children under 2 IV drug user sickle cell anemia
most common = s. aureus
neonates= groub B
under 2 = h. influenzae
IVDA = pseudomonas
sickle cell = sallmonella
gold standard osteomyelitis diagnosis
bone biopsy and bone culture
Bone Biopsy
- Presence of necrotic bone with new bone formation
Bone Culture
- Definitive
- Discontinue antibiotics for 48 hours
- Take culture through clean site
- Jamshidi needle
chronic OM with sinus tracts associated with …
squamous cell CA
tx osteomyelitis
- IV antibiotics 6-8 weeks
- Surgical debridement
- PMMA Beads
- Closed suction irrigation
acute monoarticular arthritis is assumed…
infection until proven otherwise
best tx for adequate drainage of septic arthritis
arthrotomy
- open it up and drain it
98% of puncture wounds
nails
puncture wounds are 5-7% of ER visits
treatment puncture wounds ***
open and clean it - even in office
debridement and irrigation is gold standard
- antibiotics can not overcome inadequate treatment
OM from puncture wound - what is the organism?
pseudomonas 93%
b/c sole of shoe get wet - pseudomonas likes water
patzakis classification
used to predict osteomyelitis from puncture wounds in zone 1/ forefoot
zone 3/ rearfoot is the next common
- b/c the bone is closer to skin here
