Diabetic wound mgmt Flashcards by Audris Lee

What PE finding can you do to differentiate between the eyrthema of cellulitis and an acutely inflamed Charcot joint?

dependent rubor test- the dependent rubor of an inflamed Charcot joint will go away after a few minutes of elevation whereas the erythema of cellulitis will not.

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How many grams of force is in the standard 5.07 SWM?

10g

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what type of pain do you suspect if the pain is worse at night? what about during the day?

if at night –> peripheral neuropathy

if at daytime–> likely MSK pain

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plantar ulcers are usually caused by what kind of pressure? vs. dorsal and side ulcers?

plantar ulcers- from INTERMITTENT WB pressure

dorsal and side ulcers- from CONSTANT shoe pressure

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explain the neurotraumatic destruction theory as an etiology of Charcot arthropathy.

mechnical trauma to a joint that is rendered insensitive to proprioception and pain causes joint destruction and fractures and collapse of the foot.

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explain the neurovascular destruction theory as an etiology of Charcot arthropathy.

loss of sympathetic tone to the blood vessels results in an overactive vasomotor autonomic neuropathy that leads to dysregulation of blood flow and regional hyperemia –> bone washout and ligamentous weakening –> breakdown of bone/ joint dislocation

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Wagner classification for diabetic wounds.

Grade 0- pre/post ulcerative lesion
Grade 1- partial or full-thickness superficial ulcer
Grade 2- ulcer probes to tendon or capsule
Grade 3- deep ulcer probes to bone
Grade 4- partial foot gangrene
Grade 5- whole foot gangrene

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UTSA classification of diabetic wounds.

Stage A- no infection or ischemia
Stabe B- infection
Stage C- ischemia
Stage D- infection AND ischemia 
Grade 0- pre/post ulcerative lesion
Grade 1- superficial wound
Grade 2- probes to tendon or capsule
Grade 3- probes to bone

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functional Eichenholtz classification for Charcot

Stage 1- fragmentation: red, hot swollen joint
Stage 2- coalescence: repairitive phase
Stage 3- consolidation: bony consoldiation and healing

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how do you differentiate between Charcot foot and osteomyelitis?

definitive is bone biopsy but one subtle hallmark of a neuropathic fx is that it lacks the surrounding osteopenia that typically occurs in Osteo

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what are teh anatomical Charcot classifications?

Brodsky

Sanders and Frykberg

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What is the most common location for Charcot joint arthropathy?

Lisfranc’s TMTJ

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What are other causes of Charcot arthropathy besides peripheral neuropathy related to diabetes?

(basically anything that causes neuropathy) 
alcoholism 
chemotherapy agents
leprosy
syphilis
renal dialysis 
congenital insensitivity to pain

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true or false: the patient with acute Charcot may present with a painless foot.

true- this is the reason Charcot may go misdiagnosed and the patient is worked up for other infection alone or acute gout or venous obstruction.

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What TcO2 pressure is ideal for good healing potential in diabetics? non-diabetics?

non-diabetics: >30mmHg

diabetics: 40mmgHg

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What is a left shift?

increased neutrophil percentage in the presence of band cells ( which are immature neutrophils that indicate presence of active ongoing infection)

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what is osteitis?

inflammation of the cortex

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what is osteomyelitis?

inflammation of the medullary canal

what is sequestrum?

piece of dead bone floating in pus/inflammation

what is involuctrum?

sheath of bone surrounding pus/inflammation

what is cloaca?

tract thru involucrum

what is brodie’s abscess?

chronic abscess in bone surrounded by sclerosis

what are the mechanisms by which an infectious agent causes osteomyelitis?

hematogenous spread

contiguous/direct extension

how does hematogenous spread of an infectious agent cause osteomyelitis?

infectious agent reaches medullary canal of bone from the vascular supply

how does contiguous/direct extension of an infectious agent cause osteomyelitis?

spread of infection to bone from exogenous source (like implant) or adjacent tissue that invades the cortex first and proceeds to the medullary canal

what are some characteristics of wounds you should document when describing a wound?

3D MOBB diameter, depth, drainage measure, odor, base, border

which spinal column (anterior, lateral, or posterior) is responsible for pain and temp?

lateral spinothalamic tract

which spinal column (anterior, lateral, or posterior) is responsible for vibration and proprioception?

posterior column

which spinal column (anterior, lateral, or posterior) is responsible for light touch?

anterior column

what causes diabetic neuropathy?

SORBITOL accumulation in schwann cells leads to hyperosmolarity of nerve cells --> swelling and cell lysis --> decreased nerve signal conduction

What minimum elevated value for ESR would you be concerned about for osteomyelitis?

>70mm/hr | normal is about 15-20mm/hr

Which inflammatory marker increases more rapidly over the course of days?

Unlike ESR, CRP increases rapidly over several days and returns to baseline in a week. ESR on the other hand increases slowly over the course of 10-14 days and decreases slowly

At what value of CRP are you conerned about osteomyelitis?

>3,2mg/dl with an ulcer >3mm in depth | normal CRP is 0-0.6mg/dl

What are the SIRS criteria?

HR >90 RR >20 Temp 38C (100.4F) or 10% bands

how do you define sepsis?

when 2/4 SIRS criteria met and there is a source of infection (bacteremia)

how does total contact casting (TCC) help diabetic ulcers heal?

reduces forefoot pressure by transferring about 30% of WB load from the elg directly to the cast well, as well as increases load borne by the heel and removes WB surface from met heads by making a space with soft foam around the forefoot inside the cast

For a mildly infected DFU, what antibiotics would you consider prescribing if you think it is MSSA?

Keflex (Cephalexin) | Augmentin (amoxicillin-clavulanate)

For a mildly infected DFU, what antibiotics would you consider prescribing if you suspect MRSA?

Doxycycyline | Bactrium (TMP-SMX)

For a moderately infected DFU, what antibiotics would you consider prescribing if you think it is MSSA?

Unasyn (Ampicillin-sulbactam) Invanz (Ertapenem ) Imipenem-cilastatin

For a moderately infected DFU, what antibiotics would you consider prescribing if you think it is MRSA?

Zyvox (Linezolid ) Daptomycin Vancomycin*

For a moderately infected DFU which you suspect Pseudomonas, what antibiotic would you prescribe?

Zosyn (piperacillin-tazobactam)

What is the goal of treatment both surgical and non-surgical for a Charcot foot deformity?

to create a stable and functional plantigrade foot that allows ambulation with available footwear and orthoses

What does CROW walker stand for?

charcot restraint orthotic walker (CROW)

how many glucose points does 1% in HbA1c equal?

20ish