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Urgent Care Guide > Skin 2 > Flashcards

Skin 2 Flashcards

1
Q

cellulitis

A

infection of the subcutaneous tissue and deep dermis, usually group A strep or S. aureus

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2
Q

erysipelis

A

cellulitis limited to the dermis usually group A strep

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3
Q

cellulitis may occur when

A

after disruption of skin

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4
Q

cellulitis - clinical pres
3

A
  1. fever
  2. pain
  3. drainage
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5
Q

cellulitis - hx, ask about

A

household or close contracts w/ similar infections (MRSA)

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6
Q

cellulitis - pts may come in concerned about what

A

a spider bite

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7
Q

cellulitis - PE findings
5

A
  1. erythema
  2. vague margins
  3. edema or induration
  4. warmth
  5. +/- drainage
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8
Q

erysipelas - PE findings
4

A
  1. erythema
  2. well defined margins
  3. raised
  4. beefy red in color
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9
Q

cellulitis - constitutional PE findings
3

A
  1. +/- fever
  2. toxic appearance
  3. diaphoresis
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10
Q

cellulitis - skin PE describe what
9

A
  1. size
  2. coloration
  3. edema/pitting edema
  4. margins
  5. induration
  6. fluctuance
  7. crepitus
  8. pain w/ palpation
  9. drainage
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11
Q

cellulitis - MS PE, if cellulitis overlies a joint, describe what
2

A
  1. effusion
  2. passive/active ROM (severe pain or lack of passive ROM is consistent w/ septic joint)
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12
Q

cellulitis - lymph systen, PE note what

A

associated lymphadenopathy or evidence of lymphangitis

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13
Q

cellulitis - consider wound cultures when

A

starting abx when purulence or drainage present

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14
Q

cellulitis - img/testing consider what
3

A
  1. wound culture
  2. US of extremity if hx/ and concern for for DVT
  3. plain radiographs
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15
Q

cellulitis - consider US of extremity when

A

hx and exam concern for DVT or underlying abscess

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16
Q

cellulitis - consider plain radiographs if concern for
3

A

osteomyelitis/foreign body/subcutaneous emphysema

17
Q

cellulitis DD - local reactions to bites or stings
4

A
  1. usually rapid onset and not cellulitis (abx not indicated)
  2. warmth, erythema, edema present
  3. edema usually increased for up to 72 hours after exposure, then recedes
  4. itching is predominant symptom
18
Q

cellulitis DD - chornic venous stasis
3

A
  1. usually bilateral
  2. chornic
  3. afebrile
19
Q

cellulitis DD - DVT
5

A
  1. warmth
  2. pain
  3. erythema
  4. unilateral edema
  5. get US to confirm
20
Q

purulent cellulitis - suspect what

A

MRSA

21
Q

purulent cellulitis - tx overview
3

A
  1. I&D w/ adequate anesthesia is tx of choice
  2. incision packing is controversial
  3. wound cultures prior to abx start
22
Q

purulent cellulitis - abx choices
3

A
  1. bactrim DS 1-2 tabs (DS dose is 800-150) (P 5 mg/kg TMP) PO BID x 5 days
  2. clindamycin 450 mg (P 10 mg/kg) PO q8h
  3. doxycycline 100 mg PO BID
23
Q

non purulent cellulitis - rx

A

5 days
1. cephalexin 500 mg (P 6.25 mg/kg) PO q6H
2. if severe PNC allergy - clindamycin 450 mg (P 10 mg/kg) PO q8H

24
Q

all cellulitis tx duration

A

5 days per CDC - some may need longer course if not improving after 5 days

25
Q

puncture wound - through the shoe, the most common organism is

A

Pseudomonas

26
Q

puncture wound through shoe - abx coverage

A

Pseudomonas converage - give fluoroquinolone such as cipro

27
Q

puncture wounds - consider what imaging and f/u

A

radiograph for OM/foreign body/subcuntaenous emphysema
podiatry f/u for puncture through shoe

28
Q

diabetic foot

A

infected wound usually on plantar aspect of the foot

29
Q

diabetic foot categories
3

A
  1. mild infection
  2. mod infection
  3. severe infection
30
Q

diabetic foot - mild infection

A

0.5-2 cm involving only the skin and subcutaneous tissue; can be tx OP

31
Q

diabetic foot mild infection tx rx
3

A
  1. cephalexin 500 mg PO q6h
  2. MRSA suspected then ADD: doxy 100 mg PO BID OR Bactrim DS 800/150 mg PO BID
  3. PCN allergy: replace cephalexin w/ clindamycin 450 mg PO q8H
32
Q

diabetic foot mod infection

A

2 cm or greater, may involve deeper tissue or bone, and no systemic symptoms are present

33
Q

diabetic foot mod infection - w/u
3

A
  1. consider ER referral for w/u and IV abx
  2. x ray to r/o OM
  3. OP mgmt w/ oral abx may be appropriate given pt preference and close f/u with PCP or podiatry in 24-48 hours
34
Q

diabetic foot severe infection

A

systemic s/sx, leukocytosis

35
Q

diabetic foot severe infection w/u

A

ER, may need surgical intervention

Urgent Care Guide (38 decks)

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