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NU734 Acute Care I > Nu 735 SKIN > Flashcards

Nu 735 SKIN Flashcards

1
Q

Cellultis
What is it ?

A

*** Acute Inflammatory **Condition of skin characerized by Localized:
* Pain, Erythema, Swelling, Heat
* Usualy infection of LE but can be anywhere

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2
Q

Cellulitis caused

A
  • Indigenous Flora (Colonizing Skin ) or
  • Exogenous Bacteria : Wide variety.
  • Access Epidermitis: from cracks, abrasions, cuts, burns, bites.
  • If skin compromised can develop cellulitis
  • MRSA Replacing MSSA inpatien & outpatient settin
    *
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3
Q

Purulent VS Non-Purulent

A
  • Purulet Cellulits: MRSA/MSSA - Focal infection
  • Non-Purelent : S Pyogenes > Rapid Spread > Diffuse Associates Lyphagitis
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4
Q

Cellulits

*Most common Portal of Entry :
Healthy person LE Due to

A
  • **Web intertrigo with fissuring **
  • Tinea Pedis : Complicated By
    Intertrigo is not inflammatory skin condition it lead to fungal to** bacterial i**nfection
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5
Q

Cellulitis
Most common bacteria

A

> ** Gram positive cocci : **
Group A beta hemolytic &
S. aureus

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6
Q

S Pyogenes

A

non -purulent
Rapidly spread
Associate w Lymphagitis

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7
Q

Cellulits :
Rare Bacterian

A

**Gram Negative **
**Pseudomonas Aeruginosa **
Occurs in :
* Hospitanlized and Immunocompromized pt
* Steping on Nail : Deep Tissue Injury
* **Pseumomonas = DTI **

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8
Q

Cellulitis:
Recurrent

A

**Streptococcal Cellulitsi : Group A, C, or G **

  • Venous Statis, Saphenous Venectomy From CABG
  • Chronic Lymphedema.
  • Lymph node dissection
  • Milroy Disease (disease that effect the function of lymphatic System )
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9
Q

CEllulits :
Elderly Population

A

With DM and PVD
Group B Step: **Streptoccocus Agalactiae **-

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10
Q

Cellulitis Clinical Manifestations

A

Classic Findings:
* Pain, Erythema, Swelling, Heat
* Begins as Small Tender Patch
* Expands over Hours : 6 to 36 HRs

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11
Q

Cellulits : Labs

A
  • Leukocytosis
  • At least Neutrophilia
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12
Q

B/L Cellulitis

A
  • Very uncommon
  • DDx Statis Dermatitis
  • **Consider Crytococcal **
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13
Q

Worsening Infection

A
  • Chills, Fever, malaise
  • Lymphagtitis and Lymphdenopathy
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14
Q

Cellulitis : Complications

A

Septicemia
And
Shock

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14
Q

Cellultis :
Animal or Human Bites

A
  • Augementin
  • Ampicillin
  • Cefoxitin ( 2nd Generation )
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14
Q

Cellulits TX:
Empirical TX

A
  • Cover for both Strep and Steph : Gm +
    *
  • Cefazolin 1gram TID (1st generation Cef) OR
  • Rocephin
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15
Q

Cellulitis DX

A
  • Clinical Observation:
  • R/O Statis Dermatitis , DVT vs Cellulitis
  • Definitive DX: Wound culture and Gram’s stain( from wound)
  • Skip Biopsy: Immunocompromised pt looking for uncommon Bacteria
    *
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16
Q

Cellulits :
Pseudomonas Aeroginosa

A

**** Most common Penetrating injury Stepping on Nail
**ABG Coverage: **
** Gram negative **

  • **Aminoglycoside **(Gentamycin )
  • 3rd gen Cephalosporin (Cefriaxone; Cefotaxine, Cephaxide)
  • Semi-Synthetic PNC (Zosyn )
  • Fluoroquinolone (Ciprofloxacin; Levofloxacin )
  • For 7 to 10 days
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17
Q

Diabetic Foot Ulcer
Overview

A
  • Leading cause of Non-Traumatic LE ambutation
  • Major source of Morbidity
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18
Q

DM Ulcer :

**Reason of Increased incidence of ulcer Involves
Multiple Factors **

A

* Neuropathy & Abnormal foot Biomechanics : Interferes with normal Protective Mechanisms
* PAD & Poor wound Healing : Impeded Integrity

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19
Q

DM Ulcers: Risk Factors

A

Male, DM > 10 yrs, smoking, Visual impairment, Poor Glycemic control, Dialsys

**Attentin to Risk Factors :
PVd, smoking, Dyslipidemia, HTN, Obesity, Glycemic Control: Impove

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20
Q

DM Ulcers: Common Areas

A

Great Toe
Metatarsophlangeal
Plantar
14 to 24% Undergo Amputation

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20
Q

DM Foot Ulcers:
Clinical Findings

A
  • Asymptomatic vs Symptomatic
  • Plantar Surgace: Most common Site
  • Nerupatic Ulcer vs Infection (Cellulitis around )
  • Gas Gangrene w/c Clostriial
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21
Q

DU: Infectious Etiology

A

Multiple Organisms:
* **Aerobic Gram-positive Cocci **: Most common (Staphylococus species; Streptococcus species; Group A, B, MRSA )
* Aerobic & Anaerobic Gram negative Bacilli

Empirical Coverrege

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21
Q

DM Ulcer : TX Plan

A
  • Identification of High-Risk Patient
  • Education and Prevention
  • Anual Foot Exam
  • Screening the Asymtomatic for PAD ( > 50 yrs with DM; ABI (Ankle Brakial Index ultrasound check for PVD for high risk pt
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22
Q

DM: Patient Education

A
  • Daily Inspection feet and fot Hygiene
  • Avoidance of self TX
  • Prompt consultation (podiatry)
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23
Q

DM Ulcer: Risk Factor Modifications

A
  • Orthotic Shoes and Devices
  • Callus Management and nail Care
  • Prophylactic Measures: Reduce abnormal bone abnormalities pressure
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24
Q

DM Ulcer DX

A

I**nitial Imaging **
* Plain Radiography (XRAY )
* MRI (R/O Osteomyelitis)
* Nuclear Medicine tagged WBC ( if pt has metal in a body)

laboratry: CBC, CMP, Wound & BC

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25
Q

DM Ulcer

DX: Mild Infection tx

A

PO **Cephlosporin (Augmentin ) **

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26
Q

DM Ulcer: Prior Hx MRSA

A

Clindamycin (Baware C/Diff)
Docycyline or Bacrim (watch DM pt can lead to AKI )

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27
Q

DM Ulcer: Severe Cases

A

**Empiric Coverage IV ABT: **
Cover : Staph, Strep, Gram negative Aerobic and Anaerobes
Vancomycin + Beta Lactam Inhibitors (Zosyn or Cephapin ) or Carbapenem

**Vancomycin + Fluroquinolone (Ciprofloxacin; Levoflaxacin target (gm - ) + Flagyl (anarobic coverage)

*** Vancomycin and Cephapime (4th ) most common pharmacy does

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28
Q

Dm Ulcer: Infectious Etiology

A

Multiple Organisms :
* **Aerobic Gram (+) Cocci **- most common (Stephyloccocus species, Steptococcus Species, A+ B , MRSA )
* Aerobic + Anaerobic Gr (-) Bacilli

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29
Q

Foot Osemoyelitis :
Epidemiology

A
  • DM, PAD, Perepheral Neuropathy, post Surgery
  • 20 to 60% will get Oseomyelitis
30
Q
A
31
Q

Foot Osteomyelitis : Entry

A

Exogeneous insult

  • Complicatio of deep pressure Ulcers
  • Impaire wound healing after Surgery
  • DM Incidence 30 to 40 cases /1000/year
  • Osteomyeltis : 20 to 60% will get confirmed Osteomyeltis
  • Increase risk for amputation
    *
32
Q

Foot Osteomylitis :
Most common Pathogens

A

S. Aureous
Anaerobes
Various gram Negative Bacilli

33
Q

Osteomyelitis DX

A

**MRI : **
80 to 100% Sensitivity
80to 90% Specificity
Probe to bone : prediction

34
Q

Ostemyeltitis TX

A
  • Antibiotics based on Bone Culture
  • Empiric Therapy if no Culture
  • Gm + considere MRSA
    * Risk for P Aeruginosa: Antipsedumonal Covereage
35
Q

Osteo :
Risk for P aeroginosa

A

antipseumomonal coverage (exposed to water )
* Zosyn
* CEFEPIME

36
Q

Osteo
ABT within last month

A

Clindomysin and Fluoroquinolon (Levo and cipro)

37
Q

Osteo
lenth of ABT

A

Wound debridement plus 4 to 6 wks ABT
Dead bone still present : Long term ABX for 3 month

38
Q

Periprosthetic Joint Infectious (PJI)
Overview

A

****Impalnted Material **
* Highly susceptible to Local Infection
* Exogeneous or Hetogenous insult
* Covered with Host Proteins : Favors Staphylococci adherence
* Form a biofilm

39
Q

PJI
Common Organism

A

Stephlococcus auresous and Coagulase
Cutibaterium Acnes

40
Q

PJI
Cutibaterium Acnes

A

Causes 1/3 PJI shoulder infection
Associate with cronic PJI

41
Q

PJI : Traditional Classification

A
  • Early: <3 months after implant
  • Delayed: 3 to 24 months after Implant
  • Late: > 2 yrs after Implant
42
Q

PJI : Hematogenous

A
  • S aureus
  • New onset of Pain
  • No initial inflammatory signs
  • Sepsis Syndrome dominates clinical Pictur
43
Q

PJI Chronic

A

Joint effusion
Local and chronic pain
Implant loosening
Sinus tract

44
Q

PJI

DX

A

labs: CBC, CRP, ESR

Arthrocentesis : for Synovial Fluid Analaysis
*Early onset PJI: > 10,000cells
* Late onsetPJI: > 3000 cell

Obtain Culture

45
Q

PJI
XRAY and CT and MRI

A
  • **XRAY: Identify effusion; Abnormal findings **
  • **CT and MRI: **
  • Sinus tract
  • Detect soft tissue infection
  • Prosthetic loosening
  • Bone erosion
  • Effusion

Three Phase Bone Scan : Hightly Sensitive, not specific

46
Q

PJI
Diagnosis : Major
one major critieria EXist

A

Two +
Periprosthetic Cultures With
Phenotypically Identical Organisms

A sinus Tract communicating with the Joint

47
Q

PJI Minor Criteria

A
  • Elevated CRP and ESR
  • Elevated Synovial fluids WBC count or ++
  • Change o Leukocyte Esterase test strip
  • Elevated synovial fluids
  • Presence of purulence in the affected joint
  • Positive Histolici analysis of periprosthetic tissue
  • A single positive culture
48
Q

PJI Treatment

A

Rifampin +Nafcillin +Vancomycin
Rifampin - W biofilm activity

Gram negative - Fluoroquinolones - Activity agoinst biofilms

49
Q

Sternal Osteomyelitis
OVerview

A
  • Low Incidence
  • Primarily after Sternal surgery
    *** Caused: Exogeneous Organisms rarely Hematogenous Organism **
  • **Exogeneous Organisms : ( Sternal trauma, sterna fracture and Manubriosternal septic arthritis
  • Rarely caused by Hematogenous seeding
50
Q

Sternal Osteomyelitis

Risk Factors

A

DM, Obesity, HIV, CRF, ETOH, Liver Cirrhosis
Radiotherapy
Cardiopulmonary Resuscitation
Emergency Surgery
Bilaterina intanal mammary is
Re-Exploration

51
Q

Sternal Osteomyelitis
Causative Organisms or pathogens

A

*** Staphlococcus Aureus : **Most common Hematogenous
Caugulase-negative Staphylococci: Sternal wire Infection
Fungal infections : candida
Pseudomanana aerogunosa : IVDA
Salmonella : Siclel cell Anemia
M Tuberculosis : Endemic areas or prefiously infected
Plymicrobial Infections : Indicative of exogenous seperinfection

52
Q

Sternal Osteomyeltitis
Sign and symptoms

A

Fever
Increased Local pain
Erythema
wound discharge
sternal instability

53
Q

Sternal Ostemyelitis
Complicatiosns

A

**Contiguous mediastritnitis **
High mortality
Life threateming condition
inflammatiion of mediastrinal structures
Physiologic compromise bleeding and sepsis

54
Q

Sternal Osteomyeltis
Diagnosis

A

Labs: CBC, BMP, ESR, CRP, BC
**Tissue Sampling needed: Three sample needed
1. deep Biopsies
2. Differenctiate b/w colonization and infection
3. Superficial swabs: Non -diagnosis and misleading

**Imaging: > MRI > Gold Standard > Detection of Osteomyelitis

55
Q

Sternal Osteomyeltitis Threatment Plan

A

Antibiotic Plan :
* Staphylococci spp
* Nafcillin + Rifampin
* MRSA: add Vanco or Daptomycin
* Narrow antibiotics with confirmed pathogens

56
Q

Sternal Osteomyelitis
Duration of therapy

A
  • Without Hardware Involvement : Six Weeks Course
  • Sternal Wires Infection: 3 Months
57
Q

Sternal Osteomyelitis

A

Primary Sternal Osteomyeltis : treatment without surgery
Secondary sternal ostemomyeltis : Requires debridement

58
Q

Necrotizing FAscitis
Overview

A
  • Extensive Necrosis of Subcutaneous** Tissue and FAscia
  • Common Organisms: Group A Streptococci + Mix Facultative Anaerobic Flora
  • Mixed Flora Develop gas pattern
59
Q

Necrotizing Fascitis
Risk Factors

A

DM
IVDA
Chronic liver
Renal disease
Malignanacy
Mild Lesaration

60
Q

**Necrotizing Facititis
**Mortality Rate **

A

15 to 34 %
>70% with Toxic Shock

61
Q

Necrotizing Fascititis
Clinical manifestations

A
  • Toxic appearance
  • Buloe
  • Skin Necrosis
  • Rhabdomyolysis or DC
  • Severe pain an fever
  • Soft tissue edema and erythema
  • Red, hot, skiny, swollen and tender
    *** Pain Decreases: ** Thrombosis of small vessels
62
Q

Clostridium Perfingenis
Necrotizing FAscitis

A

Extremely Toxic
Hight mortality rate
48 hours rapid tissue invasion and sytemic toxicity

63
Q

Necrotizing Fascititis
Tx

A

IVF
Vancomycin +
Clindomycin +
Gentamicin

64
Q

Gas Gancrene
Bacterian

A

Clostridium Pertringens Produce

65
Q

Gas Gancgrene TX

A

PNC G + Clindomycin
PCN Allergy: Cefaxitin plus Clindomycin
Vanco and Flagyl Surgery

Tru Immergyr : Debritins
Hypeberic : can inhibit grown

66
Q

Myositis

A
  • Considered Tropical disease
  • Present in temperate climates
  • Emergence of HIV Infection
67
Q

Infecious Myositis

A

**Acute, Subacute, or Chronic Infection
Viral Invalvement
* Influenza, Coxsackievirus type B, dengue

68
Q

Parasitic Invasion

A

Trichinellosis
Cysticerosis
Toxoplasmosis

69
Q

Pyomyositis

A

Bacterial Infection
S aureus

70
Q

Pleurdynia

A

Definition of pain due to infection
**Coxsackievirus B **

70
Q

Myositis
Clinical Findings

A

Myalgia
Abcess formation
Myositis
Pleurodynia :
* Hallmark severe muschle pain
* Fever
* Malaise
* Headaches

71
Q

Myositis
Complications

A

Acute Rhabdomyolysis
Clotridial spp or Streptococcal myositis
Influenza virus, echoviurs, Legionella
Toxic shock Syndrome: **
Toxic shock

72
Q

Myostitis
DX

A

Imaging
* Soft tissue CT and MRI
* Determine Depth of infection
* Identify abscess
* **Invasive Procedures
**Abscess drainage
Asipiration of leading edge
Punch biopsy with frozen section
False negative resutls 80% cases
**Labss **
Culture and Gram’s stain abscess
Viral culture
PCR
Serologic evaluation of viral antibodies

73
Q
A
74
Q

Viral myositis

A

Supportive care
bedrest
IVF

75
Q

Burns:
4 types

A

1.** Thermal Burns**
External heat Source
Risk of Toxix smoke inhalation
2. **Radiation Burns **
Prolonged Exposed to Solar UV Radiation
3. **Chemical Burns **

4.** Elecrical Burns **

76
Q

Burn Depth

A
  • **Superficial( formely 1st degree)

Limited to Epedemis
Apears Red or Gray
Demonstrate excellent capillary Refill and hot blistered initially
**Partial Thinckness ( formely 2nd degree )

Involve part of dermis and czn be superficial or deep
Blisnte and wet
***Full thinckness (3drd degee) **
Extend thrugh entire dermis and underlying fat
loss of adrenal structures
Appears as white -yellow, may have black charred appearance
Stiff dry skn does not bleed cataneuous senastion is lost

77
Q
A

NU734 Acute Care I (23 decks)

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