SSTI

Question 1

abscess and purulent cellulitis think what bugs

Answer 1

i. Bugs –> S. aureus (including MRSA – about 50% are d/t MRSA)

Question 2

Nonpurulent Cellulitis think what bugs

Answer 2

Bugs -->Strep. Species (can also be caused by MSSA)
vibrio vulnificus ( brackish water)

beta hemolytic strep
( pyogenes)

Question 3

Necrotizing Skin & Soft tissue infection

Answer 3

Bugs –> Strep. Species, Anaerobes (Clostridium perfringens), S. aureus (MRSA), Gram negative species

Question 4

what are special population you want to be aware of

Answer 4

people that have been in the hospital and have a wound infection

or people that work with sea water for a living

Question 5

how to talk about amputations

Answer 5

BKA- below the kneww

AKA- above the knee

Question 6

when evaluating SSTI

Answer 6

looking for pus
feel lit

if there is a fluctuance area that gives way think of PUS

can use ULS fo this evaluation

if you knick a cellulitis you’ll see this
abscess DONE

Question 7

if no pus think

Answer 7

non purulent cellulitiis

or necrotizing infection

Question 8

utility of uLS

Answer 8

can help look for pus pockets

might be a couple centimeters below the surface

Question 9

what % of purulent infx are MRSA

Answer 9

60-80%

just consider it MRSA

Question 10

caveat for purulent cellulitis

Answer 10

a lot of oral flora for IVDU

think things outside of staph areus

Question 11

tx for abscess

Answer 11

vanco

bactrim
clindamyocin
DOXY

Question 12

when do give anbx

Answer 12

LARGE
significant cellulitis
infants
immunocompramised

he was super conservative, but sighted benefit in trials with anbx

just educated pt on what to look out for and getting into hot soapy water frequently

Question 13

sponatenous furuncle

Answer 13

NOT A SPIDER BITE
one species in mojave but brown recluse are around the Mississippi

staph areus is just gaining entry down into the follicle

Question 14

how to treat an abscess

Answer 14

ring block with bupivicane (lasts longer than lidocaine)

cc for the top

need to walk away for 10 minutes
I&D

+/- ketamine

Question 15

if a GIANT abscess

Answer 15

ketamin +propofol for general anesthesia

use the yankauer suction

use bupivicane for the end of a procedure

Question 16

what is a loop drain

Answer 16

used for bigger abscess instead of packing
stick a kelly down to grasp loop material

run it through

Question 17

what does cellulitis look like on U/S

Answer 17

cobble stoning swollen with edema

Question 18

tx for non-purulent cellulitis

Answer 18

1. Cephalexin PO/Cefazolin IV
   best
2. Dicloxacillin PO
   better for kids?
3. Clindamycin IV or PO
   this will get MRSA MSSA and strep
   but causes c. diff and it is expensive
4. Vancomycin IV

Question 19

erysipelas

Answer 19

superfiical
sharply demarcated

host response to strep bacteria

Question 20

tx of necrotizing

Answer 20

pip/taz- ZOSYN IV (unasyn too)
\+
2.	Vancomycin IV 
\+
3.	Clindamycin IV

1 and 2 are cell wall active but in the case of clinda you will stop the endotoxin process

Question 21

Polymicrobial / synergistic necrotizing bugs

Answer 21

i. Staph. of all kinds
ii. Strep. of all kinds
iii. Anaerobes of all kinds
iv. Gram negatives (less common)

Question 22

monomicrobial bugs for necrotizing SSTI (NSTI)

Answer 22

i. Strep. pyogenes (Group A Strep.)
ii. Clostridium – perfringens…novyi, sordelli
iii. Vibrio vulnificus
iv. CA-MRSA (USA 300)

will only see gas if it is clostridium
(30% of necrotizing infection)
more stippled and loess bubbled (bubble if IVDU)

Question 23

4 NSTI pattern recognition

Answer 23

1. Infected diabetic foot ulcer
2. Perineal infections
3. unexplained musculoskeletal pain
4. Injection Drug User- heroin

and ludwig’s

Question 24

perineal infxs NSTI think

Answer 24

a. Fournier’s Gangrene
b. Get urology, CT, very serious

seen more commonly in men, maybe becaus e of the fascia

Question 25

michelen mans syndrome

Answer 25

track marks ballooning in the arm of a IVDU
NSTI

leukocytosis of 35 or 40

clostridium spores is often found in black tar heroin these spore can germinate in necrotic muscle tissue

think about clostridium tentanus in hispanics

Question 26

unexplained musculoskeletal painwith NSTI

Answer 26

blotchy margin of cellulitis
think about this if there is a black/purplish dot

group A strep pyogenes

anyone can get this
same strep that causes strep throat but certain strains are more likely to cause myositis

fasciitis with abnormal VS and on ULS fluid
again strep pyogenies

pain out of proportion with unexplained lactic acidosis