Skin 4 Flashcards
1
Q
abscess
A
puss in the dermis and/or subcutaneous tissues
2
Q
folliculitis
A
small abscess orignating in hair follicle; may progress to furunculosis or carbuncle
3
Q
felon
A
abscess in pulp space of finger
4
Q
abscess in pulp space of finger
A
felon
5
Q
skin abscess - hx
2
A
- boil or painful, swollen lump w/ or w/o drainage
- pts may erroneously report “spider bite”
6
Q
felon - clinical pres
3
A
abscess in distal pad of finger
exquisitely painful
swollen fingertip
7
Q
paronychia
A
minor infection or abscess in soft tissue around the nail
8
Q
skin abscess- PE findings
7
A
- tender
- edematous
- erythematous
- fluctuant mass w/ or w/o drainage
- surrounding cellulitis possible
- regional lymphadenopathy possible
- fever, tachycardia, hypotension is systemically ill
9
Q
skin abscess - img/testing
3
A
- consider US if physical exam does not clearly indicate need for I/D as overlying induration may prevent fluctuance from being apparent
- wound culture need only if giving abx
- consider radiograph if concern for foreign body
10
Q
abscess tx overview
3
A
- I/D
- warm compress in lieu of I/D for small lesions
- abx - uptodate recs abx for all patients going through ID
11
Q
abscess - ID
2
A
- most important aspect of tx
- packing use is controversial - may be helpful in larger lesions
12
Q
abscess - abx recs if cellulitis present (UTD recs abx for all getting ID)
3
A
- Bactrim DS (P 5 mg/kg) PO BID (adults w/ good renal function and 70 kg or more, two DS BID)
- clindamycin 450 mg (P 10 mg/kg) PO q8H
- doxy 100 mg PO BID
13
Q
abscess abx duration
A
typically 5 days
14
Q
felon tx requires
A
ID
15
Q
felon ID instructions
4
A
- digital block
- longitudinal incision on ulnar side (except pinky) to avoid neurovascular bundle
- drain
- wound care
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
17
Q
felon abx duration
A
7 days
18
Q
paronychia w/ abscess
A
- ID - nerve block, drain pocket, wound care
- soak 2 x day to keep drainage open - warm water or providone iodine/betadine OTC
- 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
- warm soak 2-3 days then pat dry
- 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
- topical clindyamcin 1% to affected area BID prn
- mupirocin 2% ointment to affected area q8h prn
- topical erythromycin 2% to affected area BID prn
- chlorhexidine containing antiseptic cleanser daily for 1-2 weeks
23
Q
skin abscesses - when to refer to ER
3
A
- failure of I/D or oral abx
- sx of systemic illness
- rapid progression or crepitus (may indicate nec fasc)
24
Q
burns - what to asking for hx
5
A
- how did the burn occur
- type of contact - liquid, chemicals, vapor, blast injury
- duration of exposure
- open or closed environment
- inhalation injury associated
25
TBSA chart for burns does not apply to what burns
superficial burns
26
burns - most concerning locations
7
1. face
2. ears
3. eyes
4. hands
5. feet
6. perineum
7. circumferential
27
superficial burns - PE findings
5
1. red
2. no blisters
3. blanchable
4. very sensitive
5. soft to touch
28
superficial burns - heals when
1 week
29
superficial partial-thickness burns - PE findings
5
1. red
2. blisters
3. blanchable
4. very sensitive
5. soft to touch
30
superficial partial-thicken burns heals when
1-2 weeks
31
deep partial thickness burns - PE findings
5
1. red or white
2. NO blisters
3. may blanch
4. slightly sensitive
5. tense to touch
32
deep partial thickness burns heals when
2-3 weeks - may require grafting
33
full thickness burns - PE findings
5
1. charred
2. leathery
3. non blanchable
4. no sensation
5. stiff to touch
34
full thickness burn heals when
> 3 weeks, higher likelyhood of grafting
35
burns - img/testing
none req
36
burns tx for minor burns (superficial, superficial partial thickenss)
5
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
burns - why avoid ice or ice water
may cause frostbite
38
superficial tar burns - tx how
2
1. irrigate w/ water to cool
2. leave tar in place or remove w/ mineral oil
39
severe burns (deep partial-thickness and/or inhalation injury) - tx
3
1. efere to ED via EMS
2. airway mgmt
3. dress w/ non adherent dressing
40
chemical burns tx
3
1. irrigate w/ tap water
2. identify product name/safety data sheet
3. call poison control
41
burns medications
3
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
role of silver sulfadiazine in burns
no longer recommended except for highly contaminated or infected wounds
43
burns - when to refer to ED
6
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
burns TBSA - what percentage do you sent to ER
adults - 10% or greater TBSA
children and elderly - 5% or greater TBSA
