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Diabetic wound mgmt Flashcards

1
Q

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

A

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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2
Q

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

A

10g

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3
Q

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

A

if at night –> peripheral neuropathy

if at daytime–> likely MSK pain

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4
Q

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

A

plantar ulcers- from INTERMITTENT WB pressure

dorsal and side ulcers- from CONSTANT shoe pressure

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5
Q

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

A

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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6
Q

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

A

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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7
Q

Wagner classification for diabetic wounds.

A

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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8
Q

UTSA classification of diabetic wounds.

A 
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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9
Q

functional Eichenholtz classification for Charcot

A

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

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10
Q

how do you differentiate between Charcot foot and osteomyelitis?

A

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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11
Q

what are teh anatomical Charcot classifications?

A

Brodsky

Sanders and Frykberg

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12
Q

What is the most common location for Charcot joint arthropathy?

A

Lisfranc’s TMTJ

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13
Q

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

A 
(basically anything that causes neuropathy) 
alcoholism 
chemotherapy agents
leprosy
syphilis
renal dialysis 
congenital insensitivity to pain
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14
Q

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

A

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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15
Q

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

A

non-diabetics: >30mmHg

diabetics: 40mmgHg

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16
Q

What is a left shift?

A

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

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17
Q

what is osteitis?

A

inflammation of the cortex

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18
Q

what is osteomyelitis?

A

inflammation of the medullary canal

19
Q

what is sequestrum?

A

piece of dead bone floating in pus/inflammation

20
Q

what is involuctrum?

A

sheath of bone surrounding pus/inflammation

21
Q

what is cloaca?

A

tract thru involucrum

22
Q

what is brodie’s abscess?

A

chronic abscess in bone surrounded by sclerosis

23
Q

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

A

hematogenous spread

contiguous/direct extension

24
Q

how does hematogenous spread of an infectious agent cause osteomyelitis?

A

infectious agent reaches medullary canal of bone from the vascular supply

25
Q

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

A

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

26
Q

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

A

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

27
Q

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

A

lateral spinothalamic tract

28
Q

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

A

posterior column

29
Q

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

A

anterior column

30
Q

what causes diabetic neuropathy?

A

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

31
Q

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

A

> 70mm/hr

normal is about 15-20mm/hr

32
Q

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

A

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

33
Q

At what value of CRP are you conerned about osteomyelitis?

A

> 3,2mg/dl with an ulcer >3mm in depth

normal CRP is 0-0.6mg/dl

34
Q

What are the SIRS criteria?

A

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

35
Q

how do you define sepsis?

A

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

36
Q

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

A

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

37
Q

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

A

Keflex (Cephalexin)

Augmentin (amoxicillin-clavulanate)

38
Q

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

A

Doxycycyline

Bactrium (TMP-SMX)

39
Q

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

A

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

40
Q

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

A

Zyvox (Linezolid )
Daptomycin
Vancomycin*

41
Q

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

A

Zosyn (piperacillin-tazobactam)

42
Q

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

A

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

43
Q

What does CROW walker stand for?

A

charcot restraint orthotic walker (CROW)

44
Q

how many glucose points does 1% in HbA1c equal?

A

20ish

Pimp Questions (21 decks)

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