Cellulitis

Question 1

What issue / tx
An acute bacterial infection of the dermis and subcutaneous (SC) tissue
1) Presents with the (4) classic signs of inflammation:
-(a) Erythema
-(b) Edema
-(c) Tenderness to palpation
-(d) Elevated skin temperature surrounding area of infection
2) Location:
-(a) Unilateral lower-extremity involvement is typical and systemic symptoms are usually absent
3) Typically occurs near surgical wounds and trauma sites.
4) Symptoms.
-(a) Pain, itching, and/or burning
-(b) Fever, chills, and malaise
5) Physical Exam
-(a) Localized pain and tenderness with erythema, induration, swelling, and warmth
-(b) Regional lymphadenopathy
-(c) Purulent drainage (from abscesses)

Answer 1

Cellulitis
Treatment
(1) Demarcate area w/a sharpie to measure progress once you start treatment.
(2) Immobilize and elevate involved limb to reduce swelling.
(3) Sterile saline dressings or cool aluminum acetate compresses for pain relief.
(4) Compression stocking for edema.
(5) Acetaminophen +/- NSAIDs for pain relief.
(6) Tetanus immunization if needed, particularly if there is an open (traumatic) wound.
(7) Antimicrobial treatment:
-(a)Non-purulent cellulitis (target treatment toward â-hemolytic streptococci and MSSA)
—1)Cephalexin 500 mg PO q6h
—2)Dicloxacillin 500 mg PO q6h
-(b)Purulent cellulitis (probable CA-MRSA)
—1)Clindamycin 450mg PO
—2)Trimethoprim-sulfamethoxazole (TMP-SMX) 1 DS tab PO BID
—3)Doxycycline 100 mg PO BID
-(c)Human/animal Bites
—1)Amoxicillin + clavulanic acid (Augmentin)

Question 2

Cellulitis Consider Med advice if:

(a) Elevated white blood cell count with marked ____ shift.
(b) Failure to respond to oral ________.
(c) Severe infection, suspicion of deeper or rapidly spreading infection, tissue necrosis, or severe pain.
(d) Worsening symptoms that do not resolve/improve after _________ hours of therapy.
(e) Cellulitis of the hand and face may require ______

Answer 2

a) left
b) antibiotics
d) 24 to 48
e) hospitalization

Question 3

Cellulitis Diagnostic Tests and Interpretation

(1) With good history & physical exam, primarily a clinical diagnosis.
(2) Consider labs if signs of __________
(3) Swab open cellulitis wounds for _______, however, blood cultures rarely positive(normal flora)
(4) Plain radiographs, CT, or MRI are useful if osteomyelitis, fracture, necrotizing fasciitis, retained foreign body, or underlying abscess is suspected.
(5) US to r/o ______

Answer 3

2) systemic disease (fever, heart rate >100 bpm, or systolic blood pressure <90 mm Hg)
3) culture
5) Deep Vein Thrombosis (DVT)

Question 4

Cellulitis Differential Diagnosis

Answer 4

(1) Other pyodermas
(2) Contact dermatitis
(3) Necrotizing fasciitis

Question 5

Cellulitis Complications

Answer 5

(1) Local abscess or bacteremia, sepsis
(2 )Superinfection with gram-negative organisms
(3) Lymphangitis, especially if recurrent
(4) Gangrene (bad)