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YR3S2- PM4 > wk 11- infection, venous ulcers and ischaemia > Flashcards

wk 11- infection, venous ulcers and ischaemia Flashcards

1
Q

university of texas wound classification systemic for diabetic foot wounds

A

A- no ischaemia or infection
B- infection
C-ischaemia
D- ischameia and infection

0- no wound
1- superficial wound
2- wound to deeper structures (tendon, muscle, capsule)
3- wound to bone or joint

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2
Q

2 parts to identifying DFI

A
  1. diagnosing infection based off presence of 2 or more local signs/systemic signs

local infection: 2 or more
-swelling/induration
-erythema
-local tenderness/pain
-local warmth
-purulent discharge

systemic infection:2 or more
-temp less than 36 or greater than 38 degress
-HR more than 90bpm
-resp rate more than 20 breaths/min
-WBCC elevated

  1. assessment of the severity of the diabetic foot infection

mild: erythema less than 0.5cm, infection signs

mod: erythema more than 2cm or deeper structure but no systemic symptoms

sev: systemic signs of infection

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3
Q

osteomyelitis is associated with what in a wound

A

-probe to bone
-abscess or soft tissue involvement

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4
Q

whats the issue with osteomyelitis and radiograph

A

delay in detecting bony changes in early infection

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5
Q

when should osteomyelitis be suspected

A

when ulcer lies over a bony prominence
when it fails to heal
when a toe is red and indurated

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6
Q

what do you need to diagnose osteomyelitis

A

positive results on combination of:
-probe to bone
-serum inflammatory markers
-x ray
-MRI- next imagining after x ray
-radionuclide scanning- next timaging after MRI
bone biopsy

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7
Q

probe to bone test is sensitive or specific

A

highly specific, good at ruling out condiiton when a negaitve test result

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8
Q

in high risk patients, probe to bone test is highly what?

A

sensitive- ruling in condition when positive result

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9
Q

what is gold standard culture for osteomyelitis

A

bone biopsy- gives diagnosis and antibiotic therapy

rarely used tho

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10
Q

when to conduct a bone biopsy

A

when OM is uncertain after other diagnostic measures

empiracal therapy has failed

soft tissue culture is noninformative

when considering antibiotic with higher potential for selecting resistant organisms

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11
Q

what is the gold standard for MCS/Culture of DFU

A

tissue culture (biopsy, ulcer curettage, aspiration)

these are preferred to swabbing

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12
Q

empirical therapy for mild DFI

A
  1. dicloxacillin 500mg oral 6 hourly
  2. flucoxacillin “

delayed nonsevere allergy
2. cefalexin “

immediate severe/nonsevere, delayed severe allergy
3. clindamycin 450mg oral 8 hourly

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13
Q

empirical therapy for mod DFI

A
  1. amoxicillin and clav IV 0.2g 8 hourly, if bone infected then 6 hourly

immediate nonsevere or delayed nonsevere allergy

cefalexin IV 2g 8 hourly
AND
metronidazole IV 500mg 12 hourly

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14
Q

how long a course of antibiotics for mild/mod DFI

A

1-2weeks

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15
Q

what pathogens often cause osteomyelitis and DFI

A

staph aureus

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16
Q

how long is the course of osteomyelitis antibitoics

A

6 weeks - when theres no resection of infected bone

no more than 1 week - when infected bone is resected

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17
Q

causes of venous hypertension

A
  1. obstruction
  2. valve incompetence
  3. hydrostatic (calf pump dysfunction)
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18
Q

venous hypertension causes

A

venous ulceration

19
Q

CEAP classficiation

A

c0- no signs
c1- telengectasia
c2- varicose veins
c3- oedema
c4a- eczema/pigmentation
c4b- lipodermatosclerosis or atrophe blanche
c5- healed VLU
c6- active VLU

20
Q

treatment for VLU

A
  1. topical management
    emollients
    corticosteroid
  2. wound dressing appropriate for exudate
  3. compression therapy and elevation of leg
  4. oral medication to treat conditions and infections
  5. surgery
21
Q

class compression therapy for a venous ulcer with no arterial disease

A

ABI- 0.8 -1.3

if theres no precautions present:
-peripheral neuropathy
-infection
-bad adherence

CLASS III compression: 30-40mmHG

if theres precautions:

CLASS II compression: 20-29mmHg

22
Q

class compression therapy for a mixed ulcer (venous/arterial) with an ABI 0.5-0.8

A

CLASS II compression: 20-29mmHg

23
Q

class compression therapy of a mixed ulcer (veous/arterial) with ABI 0.5 or less or above 1.3

A

no compression, vascular referral

24
Q

arterial ulcer compression therapy

A

no compression, vascular referral

25
Q

what are people with rest pain or progress from claudication to rest pain at risk of

A

significant risk of limb loss

26
Q

artieral ulcers when to debride and when not to

A

know what tissues require debridement and what dont, if unsure dont debride

27
Q

types of gangrene

A

wet, dry and gas gangrene

28
Q

dry gangrene

site, mechanism, demarcation, bacteria present, prognosis

A

site: limbs
mechanism: arterial occlusion
demarcation- present between healthy and gangerous parts
bacteria: fail to survive
prognosis - better due to little septicemia

29
Q

gas gangrene
site, mechnism, demarcation, bacteria, prognosis

A

site: limbs
mechanism: gases produced by clostriium bacteria
demarcation: no clear line
bacteria: major cause
prognosis- poor due to quick spread to surrounding tissue

30
Q

chronic ulcers are at risk of what

A

8times more at risk of SCC

31
Q

marjolin ulcer is what

A

skin cancers that originate in areas of chronic injury or irritation

32
Q

venous ulcers are present where

A

lower calf and medial mall

33
Q

characteristics of venous ulcers

A

shallow, flat margins, mod-heavy exudate, sloughy base, granulation tissue

34
Q

underlying conditions of venous ulcers

A

dvt, variose veins, obesity, pregnancy

35
Q

treatment of venous leg ulcers

A
  1. compression
  2. elevation
    3.surgery
36
Q

artieral ulcer location

A

pressure points, dorsum of toes, lateral malleolous

37
Q

characteristics of arterial ulcer

A

punched out, deep, irregular shape, necrotic tissue, minimal exudate unless infected

38
Q

condition of foot with lack of artieral supply

A

thin shiny skin, reduced hair, cool, pallor, absent/weak pulses, delayed capillary refill, gangrene

39
Q

condition of foot with venous condition

A

skin changes, oedema, normal capillary refill time

40
Q

conditions underlying artierla ulcer

A

diabetes, hypertension, smoking

41
Q

treatment of arterial ulcers

A

revascularisation
anti platelet medication
manage risk factos

42
Q

neuropthic ulcer characteristics

A

deep, surrounded by callous

43
Q

location of neuropathic ulcers

A

plantar aspect of foot, tip of toes, lateral to 5th met

44
Q

treatment for neuropathic ulcers

A

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YR3S2- PM4 (12 decks)

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