Skin 3 Flashcards
mammalian bite - general w/u
4
- evaluate need for rabies prophylaxis
- tetanus proph
- consider HIV and hep B post exposure proph (PEP) for very rare high risk human bites (blood to blood contact)
- clean wound
mammalian bite - rabies prophylaxis
2
- consider rabies immune globulin
- consider rabies vaccine dosing schedule
mammalian bite - how to cleanse wound
copiously irrigate wounds under pressure w/ NS
mammalian bite - closure of wound
primary closure not rec except for facial wounds
mammalian bite - facial wounds closure
loosely approximated w/ sutures or sterile tape
mammalian bite - mod/high risk bites include those from
3
- cat
- crush injuries
- puncture wounds
mammalian bite - mod/high risk bites tx
abx proph for 3-5 days
mammalian bite - mod/high risk bites, consider abx in patients with
4
- immunosuppression
- asplenic
- DM
- advanced liver dx
mammalian bite - mod/high risk areas, consider abx, include
4
- face
- hands
- genitals
- chronic edematous or compromised skin
mammalian bite - consider abx if there is concern for
compliance/fu
mammalian bite - infection present, tx w/ abx for how long
7-10 days
mammalian bite - infection present abx options
4
- Augmentin 875 mg (25 mg/kg) PO BID
- cefuroxime 500 mg (P 15 mg/kg) PO BID + metronidazole 500 mg (P 15 mg/kg) PO q8h
- moxifloxacin 400 mg PO once daily
- clindamycin 450 mg (P 10 mg/kg) PO q8h + bactrim or cipro or doxy
rabies prophy includes (from CDC)
3
- clean wound with sterile water and povidone iodine if available
- administer immune globin - The recommended dose of HRIG is 20 IU/kg body weight. This formula applies to all age groups, including children. Administer around the wound edges until wound appears infiltrated. Best to get all immunoglobin into wound but if left over, administer in distal site to rabies vaccine. i.e. 5 cc left over, split into 2.5 cc syringes and give IM
- give rabies vaccine IM - one each on days 0 , 3, 7, and 14. A fifth dose on day 28 is recommended for persons with a confirmed or suspected immune disorder
rabies proph - where to administer
adults - deltoid
children - deltoid or anteriolateral thigh
- never in butt d/t slow absorption
rabies - what does the immune globulin provide
antibodies right away until the body can make its own
water exposure wounds rx
2
- cephalexin 500 mg PO q6h x 10 days
- severe PCN allergy - clindamycin 450 mg PO (P 10 mg/kg) q8h + levo 750 mg PO daily
water exposure wound with sewage/contaminated water add what abx
metronidazole 500 mg PO q8h
water exposure wound with salt water rx
cipro 750 mg PO BID x 10 days
fish hook removal
4
- clean wound
- consider digital block or local anesthesia
- tie suture around bend of hook
- exert downward pressure on shank to dislodge the barb then pull
soft tissue concerns - when to refer to ER
4
- failed OP tx worsening after 48 hours
- worrisome features - breast, groin, axilla, foreign material i.e. joint replacement, graft, PICC line, crepitus (nec fasc), evidence of septic joint, rapid progression of erythema
- high risk comorbs - DM, recent organ transplant, immunosuppressed
- rabies proph
herpes zoster is caused by what virus
varicella zoster virus
herpes zoster - systemic sx are ____ common
less common - HA, fatigue, fever
herpes zoster - 75% of pts have what sx
3
- prodromal pain
- itching
- tingling
herpes zoster - 3 phases of pain
- acute herpetic neuralgia that may begin preceding rash
- subacute HN may persist after rash resolves but < 4 months after onset
- post HN (PHN) > 4 months
