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Urgent Care Guide > Skin 4 > Flashcards

Skin 4 Flashcards

1
Q

abscess

A

puss in the dermis and/or subcutaneous tissues

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2
Q

folliculitis

A

small abscess orignating in hair follicle; may progress to furunculosis or carbuncle

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3
Q

felon

A

abscess in pulp space of finger

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4
Q

abscess in pulp space of finger

A

felon

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5
Q

skin abscess - hx
2

A
  1. boil or painful, swollen lump w/ or w/o drainage
  2. pts may erroneously report “spider bite”
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6
Q

felon - clinical pres
3

A

abscess in distal pad of finger
exquisitely painful
swollen fingertip

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7
Q

paronychia

A

minor infection or abscess in soft tissue around the nail

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8
Q

skin abscess- PE findings
7

A
  1. tender
  2. edematous
  3. erythematous
  4. fluctuant mass w/ or w/o drainage
  5. surrounding cellulitis possible
  6. regional lymphadenopathy possible
  7. fever, tachycardia, hypotension is systemically ill
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9
Q

skin abscess - img/testing
3

A
  1. consider US if physical exam does not clearly indicate need for I/D as overlying induration may prevent fluctuance from being apparent
  2. wound culture need only if giving abx
  3. consider radiograph if concern for foreign body
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10
Q

abscess tx overview
3

A
  1. I/D
  2. warm compress in lieu of I/D for small lesions
  3. abx - uptodate recs abx for all patients going through ID
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11
Q

abscess - ID
2

A
  1. most important aspect of tx
  2. packing use is controversial - may be helpful in larger lesions
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12
Q

abscess - abx recs if cellulitis present (UTD recs abx for all getting ID)
3

A
  1. Bactrim DS (P 5 mg/kg) PO BID (adults w/ good renal function and 70 kg or more, two DS BID)
  2. clindamycin 450 mg (P 10 mg/kg) PO q8H
  3. doxy 100 mg PO BID
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13
Q

abscess abx duration

A

typically 5 days

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14
Q

felon tx requires

A

ID

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15
Q

felon ID instructions
4

A
  1. digital block
  2. longitudinal incision on ulnar side (except pinky) to avoid neurovascular bundle
  3. drain
  4. wound care
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16
Q

felon abx - 2 sets to choose from

A

set 1 -
cephalexin 500 mg PO q6H +
Bactrim DS 1-2 tabs PO BID OR
doxy 100 mg PO BID

set 2 - clindamycin alone
clindamycin 450 mg (P 10 mg/kg) q8h PO

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17
Q

felon abx duration

A

7 days

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18
Q

paronychia w/ abscess

A
  1. ID - nerve block, drain pocket, wound care
  2. soak 2 x day to keep drainage open - warm water or providone iodine/betadine OTC
  3. possible abx - augmentin for oral flora coverage; cephalexin 500 mg PO q6h for MSSA coverage
19
Q

paronychia f/u

A

7 days

20
Q

paronychia tx w/o abscess
2

A
  1. warm soak 2-3 days then pat dry
  2. topical abx ointment - can prescribe mupirocin (topical abx) q8H day for 7 days
21
Q

folliculitis tx

A

abx recommended

22
Q

folliculitis abx recs
4

A
  1. topical clindyamcin 1% to affected area BID prn
  2. mupirocin 2% ointment to affected area q8h prn
  3. topical erythromycin 2% to affected area BID prn
  4. chlorhexidine containing antiseptic cleanser daily for 1-2 weeks
23
Q

skin abscesses - when to refer to ER
3

A
  1. failure of I/D or oral abx
  2. sx of systemic illness
  3. rapid progression or crepitus (may indicate nec fasc)
24
Q

burns - what to asking for hx
5

A
  1. how did the burn occur
  2. type of contact - liquid, chemicals, vapor, blast injury
  3. duration of exposure
  4. open or closed environment
  5. inhalation injury associated
25
Q

TBSA chart for burns does not apply to what burns

A

superficial burns

26
Q

burns - most concerning locations
7

A
  1. face
  2. ears
  3. eyes
  4. hands
  5. feet
  6. perineum
  7. circumferential
27
Q

superficial burns - PE findings
5

A
  1. red
  2. no blisters
  3. blanchable
  4. very sensitive
  5. soft to touch
28
Q

superficial burns - heals when

A

1 week

29
Q

superficial partial-thickness burns - PE findings
5

A
  1. red
  2. blisters
  3. blanchable
  4. very sensitive
  5. soft to touch
30
Q

superficial partial-thicken burns heals when

A

1-2 weeks

31
Q

deep partial thickness burns - PE findings
5

A
  1. red or white
  2. NO blisters
  3. may blanch
  4. slightly sensitive
  5. tense to touch
32
Q

deep partial thickness burns heals when

A

2-3 weeks - may require grafting

33
Q

full thickness burns - PE findings
5

A
  1. charred
  2. leathery
  3. non blanchable
  4. no sensation
  5. stiff to touch
34
Q

full thickness burn heals when

A

> 3 weeks, higher likelyhood of grafting

35
Q

burns - img/testing

A

none req

36
Q

burns tx for minor burns (superficial, superficial partial thickenss)
5

A
  1. NSAIDs, tylneol
  2. remove any garments or jewerly from area
  3. cool burn to room temp w/ NS
  4. apply topical abx ointment - bacitracin OTC (basi-trace-in)
  5. non adherent sterile dressing
37
Q

burns - why avoid ice or ice water

A

may cause frostbite

38
Q

superficial tar burns - tx how
2

A
  1. irrigate w/ water to cool
  2. leave tar in place or remove w/ mineral oil
39
Q

severe burns (deep partial-thickness and/or inhalation injury) - tx
3

A
  1. efere to ED via EMS
  2. airway mgmt
  3. dress w/ non adherent dressing
40
Q

chemical burns tx
3

A
  1. irrigate w/ tap water
  2. identify product name/safety data sheet
  3. call poison control
41
Q

burns medications
3

A
  1. analgesia
  2. tetanus prohylaxis for superficial partial-thickness burns or greater if you haven’t had one in last five years
  3. no role for steroids or abx prophy
42
Q

role of silver sulfadiazine in burns

A

no longer recommended except for highly contaminated or infected wounds

43
Q

burns - when to refer to ED
6

A
  1. all suspected inhalation injuries
  2. any full thickness burn
  3. large partial thickness burns - 10% or more TBSA for adults and 5% or more in children and elderly
  4. burns involving face, hands, perineum, major joints
  5. electrical or large chemical burns
  6. pre existing medical conditions or other complicated factors
44
Q

burns TBSA - what percentage do you sent to ER

A

adults - 10% or greater TBSA
children and elderly - 5% or greater TBSA

Urgent Care Guide (38 decks)

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