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Flashcards in SSTI Deck (26):
1

abscess and purulent cellulitis think what bugs

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

2

Nonpurulent Cellulitis think what bugs

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

beta hemolytic strep
( pyogenes)

3

Necrotizing Skin & Soft tissue infection

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

4

what are special population you want to be aware of

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

or people that work with sea water for a living

5

how to talk about amputations

BKA- below the kneww
AKA- above the knee

6

when evaluating SSTI

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

7

if no pus think

non purulent cellulitiis
or necrotizing infection

8

utility of uLS

can help look for pus pockets

might be a couple centimeters below the surface

9

what % of purulent infx are MRSA

60-80%
just consider it MRSA

10

caveat for purulent cellulitis

a lot of oral flora for IVDU
think things outside of staph areus

11

tx for abscess

vanco

bactrim
clindamyocin
DOXY

12

when do give anbx

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

13

sponatenous furuncle

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

14

how to treat an abscess

ring block with bupivicane (lasts longer than lidocaine)

cc for the top

need to walk away for 10 minutes
I&D

+/- ketamine

15

if a GIANT abscess

ketamin +propofol for general anesthesia

use the yankauer suction

use bupivicane for the end of a procedure

16

what is a loop drain

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

run it through

17

what does cellulitis look like on U/S

cobble stoning swollen with edema

18

tx for non-purulent cellulitis

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

19

erysipelas

superfiical
sharply demarcated

host response to strep bacteria

20

tx of necrotizing

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

21

Polymicrobial / synergistic necrotizing bugs

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

22

monomicrobial bugs for necrotizing SSTI (NSTI)

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)

23

4 NSTI pattern recognition

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


and ludwig's

24

perineal infxs NSTI think

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


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

25

michelen mans syndrome

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

26

unexplained musculoskeletal painwith NSTI

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