wk 11- infection, venous ulcers and ischaemia Flashcards
university of texas wound classification systemic for diabetic foot wounds
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
2 parts to identifying DFI
- 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
- 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
osteomyelitis is associated with what in a wound
-probe to bone
-abscess or soft tissue involvement
whats the issue with osteomyelitis and radiograph
delay in detecting bony changes in early infection
when should osteomyelitis be suspected
when ulcer lies over a bony prominence
when it fails to heal
when a toe is red and indurated
what do you need to diagnose osteomyelitis
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
probe to bone test is sensitive or specific
highly specific, good at ruling out condiiton when a negaitve test result
in high risk patients, probe to bone test is highly what?
sensitive- ruling in condition when positive result
what is gold standard culture for osteomyelitis
bone biopsy- gives diagnosis and antibiotic therapy
rarely used tho
when to conduct a bone biopsy
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
what is the gold standard for MCS/Culture of DFU
tissue culture (biopsy, ulcer curettage, aspiration)
these are preferred to swabbing
empirical therapy for mild DFI
- dicloxacillin 500mg oral 6 hourly
- flucoxacillin “
delayed nonsevere allergy
2. cefalexin “
immediate severe/nonsevere, delayed severe allergy
3. clindamycin 450mg oral 8 hourly
empirical therapy for mod DFI
- 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
how long a course of antibiotics for mild/mod DFI
1-2weeks
what pathogens often cause osteomyelitis and DFI
staph aureus
how long is the course of osteomyelitis antibitoics
6 weeks - when theres no resection of infected bone
no more than 1 week - when infected bone is resected
causes of venous hypertension
- obstruction
- valve incompetence
- hydrostatic (calf pump dysfunction)
venous hypertension causes
venous ulceration
CEAP classficiation
c0- no signs
c1- telengectasia
c2- varicose veins
c3- oedema
c4a- eczema/pigmentation
c4b- lipodermatosclerosis or atrophe blanche
c5- healed VLU
c6- active VLU
treatment for VLU
- topical management
emollients
corticosteroid - wound dressing appropriate for exudate
- compression therapy and elevation of leg
- oral medication to treat conditions and infections
- surgery
class compression therapy for a venous ulcer with no arterial disease
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
class compression therapy for a mixed ulcer (venous/arterial) with an ABI 0.5-0.8
CLASS II compression: 20-29mmHg
class compression therapy of a mixed ulcer (veous/arterial) with ABI 0.5 or less or above 1.3
no compression, vascular referral
arterial ulcer compression therapy
no compression, vascular referral
