Pressure Ulcers, Cellulitis, Nec Fac

Question 1

Lipodermatosclerosis

• description
• cause
• treatment

Answer 1

pigmented brawny edema, resembles inverted champagne bottle in advanced cases

caused by genetic conditions, iatrogenic, chronic infections etc

rx - compression, elevation, exercise, venoactive agents

Question 2

Statis dermatitis

Answer 2

Pigmented skin (due to hemosiderin deposition), eczematous rash - erythema, itching, scaling, erosions, crusting

Sx of venous stasis - telangiectasias, reticular veins, varicose veins

Question 3

Cellultiis and erysipelas

Answer 3

Clinical presentation - erythema, edema, warmth, petechiae or haemorrhage, superficial bullae, fever, systemic symptoms. Nearly always UNILATERAL

Erysipelas - classic butterfly involvement of face

Question 4

Orbital cellulitis

Answer 4

emergency, risk of visual loss

need CT TRO intracranial extension

Urgent surgical drainage of the sinuses or of an orbital, subperiosteal or intracranial abscess may be required to prevent loss of vision

Rx - Cefotaxime OR Cef + Fluclox

Question 5

Pressure injury staging

Question 6

Pressure Injury - treatment

Answer 6

1. Pain control
2. Nutritional supplementation (proven benefit)
3. Pressure relieving - makes sense but no RCT

Question 7

Nec Fac - categories and other similar infections

Answer 7

Type 1: Polymicrobial - anaerobic + aerobic

Type 2: Monomicrobial - GAS or other beta-haemolytic strep

Necrotizing Myositis - infection in skeletal muscles, usually post trauma/skin abrasions. Usually caused by GAS (or GBS)

Necrotizing cellulitis - usually Clostridium (perfringes or septicum) or non clostridial (polymicrobial). Will have creps under skin but no fascia/muscle involvement. Milder than nec fac

Question 8

NEC FAC - Dx and clinical presentation

Question 9

Nec Fac Treatment

Answer 9

Surgical debridement

Abx - Carbapenem OR PipTaz + Vanc/Dapto + Clinda (for 24/24 to reduce inflammation)

Others: For Strep, give IVIG - significant reduction in mortality