Term
| Who is at risk for soft tissue infections? |
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Definition
| Patients with DM, HIV, or other immunosuppressed states, peripheral vascular disease, and edema are at increased risk. |
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Term
| What are soft tissue infections? |
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Definition
| Infections that infect the dermis, subcutaneous fat, and/or fascia. |
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Term
| What are the symptoms of cellulitis? |
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Definition
| Warm, erythematous, and tender skin with well-demarcated borders. Pts may have fever, chills, regional lymphadenopathy, or lymphangitis |
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Term
| What is the DDX of cellulitis? |
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Definition
| Stasis dermatitis, necrotizing fasciitis, allergic reaction. |
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Term
| How do you treat cellulitis? |
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Definition
Demarcate borders and select antimicrobial and route on the basis of pt risk factors and clinical severity.
First Gen Cephalosporin or 2nd gen penicillin is appropriate, but consider pseudomonal coverage in DM and weigh possibility of MRSA) |
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Term
| How do you diagnose cellulitis? |
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Definition
Consider blood cultures, CBC, ESR, and radiographs if there is a possibility of deeper infection such as necrotizing fasciitis or osteomyelitis.
Lower extremity can be associated with DVT, so consider US for leg. |
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Term
| What is and who is at risk for necrotizing fasciitis? |
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Definition
| Rapidly spreading infection of the subcutaneous fat and fascia, with risk factors including DM, Immunosuppressed states, IVDU, and peripheral vascular disease. |
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Term
| How does necrotizing fasciitis present? |
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Definition
| Erythematous, warm, tender, and edematous skin that may rapidly progress to dark, indurated skin with bullae. Pts are typically more toxic appearing than those with simple cellulitis. |
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Term
| How do you assess for compartment syndrome? |
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Definition
Pulselessness
Pain
Pallor
Paresthesias
Poikilothermia
Paralysis |
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Term
| What is the DDX for necrotizing fasciitis? |
|
Definition
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Term
| How do you diagnose necrotizing fasciitis? |
|
Definition
| Radiographs and CT or MRI to look for gas and soft tissue involvement. |
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Term
| How do you treat necrotizing fasciitis? |
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Definition
Penicillin is best for group A strep coverage, with clindamycin used to shut down toxin production. Vancomycin can be added for MRSA coverage
If mixed infection: broad-spectrum penicillin with anaerobic coverage (piperacillin/tazobactam) should be used. Obtain a surgery consult for debridement and fasciotomy. |
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Term
| What are some complications of necrotizing fasciitis? |
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Definition
| May progress to compartment syndrome, shock, multiorgan failure, and death. |
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Term
| What's the difference between periorbital and orbital infection? |
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Definition
Periorbital: treat like cellulitis.
Orbital: may need surgical intervention to prevent blindness, meningitis, and cavernous sinus thrombosis |
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Term
| What are the symptoms of orbital cellulitis? |
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Definition
| Oculomotor dysfunction, proptosis, chemosis, decreased visual acuity and significant lid erythema |
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Term
| How do you diagnose orbital infections? |
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Definition
| CT, Blood cultures, and CBC |
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Term
| How do you treat orbital infections? |
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Definition
| Start broad-spectrum IV antimicrobials and request a surgical consult. |
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