What are good history questions to ask?
Onset and duration Trauma Contamination Pain Last ate or drank
ROS questions
F/C/N/V
Recent blood glucose
Drug allergies
Things to look for on x-ray
Gas
Foreign bodies
Osteo
Wound without purulence or any manifestations of inflammation
Uninfected
Cellulitis or erythema 0.5-2cm around area.
Limited to skin or superficial subcutaneous.
No local or systemic complications
Mild
Erythema greater than 2cm or involving deep structures
NO SIRS
Moderate
Local infection WITH SIRS
Severe infection
SIRS is manifested by greater than or equal to 2 of the following:
Temp >38, <36 HR >90 RR>20 PaCO2 <32 WBC >12, <4
Thick, yellow, and purulent drainage infection
MSSA
Infection with quicker onset of purulent drainage
MRSA
Deeper red infection than Staph, not as purulent
Strep
Infection with a fruity smell and green tinge
Pseudomonas
Infection with a foul smell and brown/watery discharge
Anaerobic
What are the main infecting organisms?
Staph and Strep
These present clinically on open skin, local redness and edema, extreme pain, palpable fluctuance, and fever
Abscess
What are the 4 D’s of abscess treatment?
Decompression
Drainage
Debridement
Drugs
When should surgical I&D be done?
Within 1-2 days
Should antibiotics be given for abscess treatment?
IV in hospital until signs of infection are gone
Orally upon discharge
Most common OM in podiatry?
Direct extension
What is the most common type of gas producing infection seen in DM patients?
Nonclostridial myonecrosis/nec fas such as GBS
Describe the presentation of nonclostridial myonecrosis/nec fasc
Slower developing
Skin changes from bronze to blue/back then to hemorrhagic bulla
Sharper/acidic odor
Nonclostridial myonecrosis antibiotic treatment
Empiric until gram stain back
Surgically debride ASAP
Clostridial presentation
Sudden onset w/ severe pain Heaviness Low grade fever Skin changes from bronze to blue/black to hemorrhagic bulla Non-odorous or sweet Crepitus Pain is SEVERE
Clostridial treatment
Penicillin
Aggressive debridement
HBO therapy
Surgical keys for Gas infections
Get to the OR
Aggressive debridement
Leave open
Take back to OR