Skin & Soft Tissue Disorders Flashcards
what is the MC pathogen present in dog/cat bites?
pasteurella
dog bites typically involve the ____ while cat bites involve _____
dog = face
cats = UEs
what is a major complication of a deep cat bite?
periosteum = osteomyelitis/septic arthritis
the below are three pathogens present in ____ bites
E. corrodens
GAS
staphylococcus
human bites
adult bites have a maxilary-intercanaine distance of…
> 2.5cm
Clean the surface of bites with…
povidone iodine
the below are indications for what intervention on bites/wounds?
deep wounds involving bone, tendon, joint, major structures
facial lac
neurovasc compromise
infx
surgical consult
The below require…
Deep puncture wounds
Moderate to severe wounds with associated crush injury
Underlying venous and or lymphatic compromise
Wounds on hands, genitalia, face or in close contact with bone/joint
Wounds requiring closure
Compromised hosts
prophylactic abx
Mgmt of plantar puncture… (4)
x-ray
cleansing
FB removal + closure
tetanus
Needle stick wound cleansing…
soap, water, alcohol
What is an important consideration of needle stick injuries?
HIV/HBV/HCV status
Post exposure prophylaxis
the below are indications for _______
• Extension into sub Q • Decrease healing time • Reduce likelihood of infection • Decrease scar formation • Repair loss of structure or function • Improve cosmesis
wound closure
4 C/Is of closure
contamination
> 12 hrs
FB
tendon/nerve/artery involvement
What type of wound?
• Surgical incisions • No involvement of GU, GI, respiratory tracts
clean
What type of wound?
•
Involvement of GU, GI, respiratory tracts
clean-contaminated
What type of wound?
• Gross spillage into surgical wound (bile, stool) • Traumatic wounds
contaminated
What type of wound?
•
Established infection (I&D abscess)
•
Gross contamination
infected
What type of wound?
• All layers closed • Best chance for minimal scarring • Clean/clean contaminated wounds
primary intention
What type of wound?
• Deep layers closed • Superficial layers left to granulate • Can leave wide scar • Requires frequent wound care
secondary intention
What type of wound?
• Deep layers closed primarily • Superficial layers closed in 4 5 days after infection is not a concern
delayed primary intention
3 absorbable suture types…
vicryl
PDS
chromic gut
What type of suture?
absorbable
duration 6 mo
PDS
What type of suture
absorbable
duration 60-90 days
Vicryl
How long must sutures be dry?
48 hours
signs of infx post-suture…
pain, swelling, redness, drainage
post-suture activity restriction?
PRN
analgesia post-suture…
OTCs
are prophylactic abx indicated for small, uncomplicated lacs?
no
2 important factors to decrease infx risk…
debridement
FB removal
shave before suturing?
no
most important means of decreasing infection risk
irrigation
What wounds need a re-check in 48-72 hours after closure?
highly contaminated wounds
In whom would absorbable sutures be favorable?
peds and elderly
Nonpurulent infection w.:
local pain swelling tenderness erythema warmth
cellulitis
The below are signs of what type of infx?
• Violaceous bullae • Cutaneous hemorrhage • Skin sloughing • Skin anesthesia • Rapid progression • Gas in tissue
severe deep tissue infx
3 considerations of outpatient management of cellulitis…
elevation
empiric abx
f/u 48-72 hours
The below are indications for ____ management of cellulitis
Facial cellulitis of odontogenic origin
Immunocompromised patients
Orbital cellulitis • Lymphedema • Cardiac, hepatic, or renal failure
Patient with comorbidities:
Cellulitis affecting more than ¼ of an extremity
inpatient
which abx are mainstay of cellulitis tx?
amoxicillin, augmentin (beta lactams)
Which abx for cellulitis?
strep or MRSA coverage
cephalaxin
Which abx for cellulitis?
G- organisms
ceftriaxone
Which abx for cellulitis?
no MRSA
PCN allergy
macrolides (azithro, erythro, clarithro)
Which abx for cellulitis?
Broad spectrum
FLQs (cipro, levo)
duration of tx for non-purulent cellulitis
5 days
Abx for mild cellulitis infection…(4)
PCN
cephalosporin
Diclox
clinda
abx for moderate cellulitis infection
PCN
Ceftriaxone
cefazolin
clinda
Tx for recurrent cellulitis (3-4 episodes a year)
PCN or erythro BID x 4-52 weeks
The below are at increased risk for what skin infx?
staph carrier
break in skin
immunocompromised
abscess
the below are indications for what mgmt of abscess?
• Perirectal abscesses • Anterior and lateral neck abscesses • Hand abscesses • Abscesses adjacent to vital nerves or blood vessels • Breast abscesses near areola and nipple
surgical
abscess f/u
24-48 hours
how often to change packing in abscess?
q 24 hrs
if recurrent abscess/infx… what can be done?
daily chlorhexidine baths
MRSA decolonization procedure… (3)
BID nasal mupirocin
QD chlorhexidine wash
daily decon of personal items
MC burn wound infection…
staph aureus
mgmt of burn wound infx… (3)
avoid hypothermia
Cx
systemic abx
mgmt of MRSA burn wound infx
IV cefazolin/clinda/vanco
anesthetize before or after wound irrigation?
before
Necrotising fasciitis spares _______ tissue
spares muscle
pathogens of necrotising fasciitis…
polymicrobial aeurobes/anaerobes
GAS or beta hemolytic strep
Infection of perineum involving scrotum…
fournier’s gangrene
Patient p/w
severe pain in anterior abd. wall
migration to gluteal muscle, scrotum, penis
fournier’s gangrene
On PE, you notice…
tense edema crepitus fever tachy hypotension
fournier’s gangrene
Tx for fournier’s gangrene…
dibridement, broad spectrum abx
