Wounds / Soft tissue Injury/Joints/STD Flashcards
Most frequent pathogen isolated from plantar puncture wound osteomyelitis
Pseudomonas aeruginosa
particularly when puncture goes through an athletic shoe
Recommendation for use of prophylactic antiobiotics in puncture wounds
- high risk patients (diabetics, immunocompromised)
- Forefoot injuries (deeper)
- Puncture through athletic shoes
Antibiotic choices for puncture wounds, when indicated
- Cipro for athletic shoe punctures
- Cefazolin, Cephalexin, Cefadroxil
- Antistaph penicillins (oxacillin, dicloxacillin)
- Azithromycin
- MRSA - Bactrim or Clindamycin
Indications for primary suture closure of animal bite wounds
- Face or scalp
- Simple, no devitalized tissue, single layer
- No underlying fracture
- Host not immunocompromised
Pathogen most often causing sepsis etc in immunocompromised patients w animal bites
Capnocytophaga canimorsus
covered by Augmentin
“High risk” animal bite wounds
- Cat or human bites
- Livestock bites
- Monkey bites
- Puncture wounds
- HAND or foot wounds
- Heavily contaminated, older, or devitalized wounds
- Signs of infection at first evaluation
- Diabetic or immunocompromised patients
Catbite infection is often due to
Pasteurella multicida
covered by Augmentin
Treatment / prophylaxis for high risk bite wounds
3-5 day course of:
- Augmentin for most
- Cipro for fish bites
- Azithromycin for bartonella (cat scratch)
- *Penicillin allergic patients**
1. Doxycycline or Cefuroxime (Ceftin) for CAT bites
2. Clindamycin + Cipro for DOG bites
“cat scratch fever” caused by and treated by
Bartonella henselae
Azithromycin
Regional lymphadenopathy + mild constitutional sx developing 7-12 days after a cat bite or scratch
Cat scratch fever - bartonella henselae
Azithromycin
Pathogens associated with human bites
Staph and strep
Eikenella corrodens
Prophylaxis with Augmentin
Calcium pyrophosphate crystals,
yellow, rhomboid
positive birefringence
Pseudogout
1st line tx acute gout
NSAIDs 5-7days
Indomethacin 50mg TID
or naproxen
or Colchicine 0.6mg/h
1st line tx acute gout in renal impaired patienst
Prednisone
Narcotics
most common causes of viral arthritis in US
Parvovirus B19
Rubella
Hepatitis B
Traumatic hemarthrosis has a high association with
Ligamentous injury or an intra-articular fracture
arthritis, urethritis, and conjunctivitis
Reactive arthritis
most common STD
Chlamydia
Chlamydia + Gonorrhea tx
Azithromycin, 1 G PO single dose (Chlamyd) +
Ceftriaxone 250mg IM single dose (Gonorr)
** OK for pregnant women **
OR
Doxy 100mg PO BID x 7 days
Syphilis tx
Benzathine Penicillin G 2.4 million u IM single dose
OK for pregnant women
Doxycycline twice daily for 2 weeks may be used in penicillin-allergic patients
Syphilis diagnosis
The VDRL and rapid plasma reagin tests are used as screening tests and also, once diagnosis is made, to assess disease activity and response to treatment.
Positive results must be confirmed with an immunoassay specific for T. pallidum antibodies.
