Extremity Pain - Exam 3 Flashcards by Johannah Crumpton

______ usually involves the upper dermis. What is the MC pathogen?

erysipelas

MC group A strep

How well did you know this?

Not at all

Perfectly

_____ involves the skin and subq tissues. What is the MC pathogen?

cellulitis

MC staph

How well did you know this?

Not at all

Perfectly

What are the risk factors for cellulitis and erysipelas?

skin fissuring
maceration
burns
venous stasis
lymphedema
malnutrition

How well did you know this?

Not at all

Perfectly

How well did you know this?

Not at all

Perfectly

______ involves the upper dermis. What is the MC pathogen

erysipelas

group A strep

How well did you know this?

Not at all

Perfectly

_____ involves the skin and subcutaneous tissue. What is the MC pathogen?

cellulitis

Staph

How well did you know this?

Not at all

Perfectly

What are the risk factors for cellulitis and erysipelas?

skin fissuring
maceration
burns
venous stasis
lymphedema
malnutrition

How well did you know this?

Not at all

Perfectly

How will cellulitis and erysipelas presentation be different?

cellulitis: ill defined borders, NOT a clear margin of transition

erysipelas: will have prodromal s/s, bright red painful indurated plaques with WELL DEFINED borders

How well did you know this?

Not at all

Perfectly

What are the indications to order labs on a pt with cellulitis or erysipelas?

Systemic symptoms or extensive skin involvement

Immunosuppression or multiple comorbidities

Immersion injury or infected animal bite

Failed outpatient therapy

aka not everyone needs labs!! only if cormorbid or systemic symptoms

How well did you know this?

Not at all

Perfectly

_____ can be ordered on pts with concern for a deep abscess vs cellulitis

bedside US

How well did you know this?

Not at all

Perfectly

What imaging should you order if you have concerns for osteomyelitis or necrotizing soft tissue infection?

xray: bone

CT: bone, soft tissue (CT with IV contrast for necrotizing soft tissue infection)

How well did you know this?

Not at all

Perfectly

How long does it take for osteomyelitis to show on the xray?

2 weeks

How well did you know this?

Not at all

Perfectly

What is the tx for cell/erysipelas?

no MRSA risk: cephalexin

MRA risk: bactrim or (doxy PLUS amox)

supportive therapy: rest, cool compresses, elevation

How well did you know this?

Not at all

Perfectly

What are the return procautions in cellulitis and erysipelas? When do they need to follow up?

return: if any s/s of abscess formation, sepsis

draw circle around swelling and if swelling extends past 2 inches then need to return to PCP/ER

follow up in 48-72 hours

How well did you know this?

Not at all

Perfectly

What are the indications for admission in cell/erysi? What is the inpt tx?

systemic toxicity or signs of sepsis

No MRSA Risk - IV cefazolin

MRSA risk - add IV vancomycin

How well did you know this?

Not at all

Perfectly

What are the s/s of sepsis that would indicate admission in cellulitis/erysipelas?

How well did you know this?

Not at all

Perfectly

**What are the MRSA risk factors? When would you use them for this test?

When deciding what abx to use in cell/erysipelas

How well did you know this?

Not at all

Perfectly

What are the risk factors for cutaneous abscess? What is the MC pathogen?

trauma (abrasions or shaving)
skin foreign bodies
insect bites
IV drug abuse

MC pathogens - S. aureus, MRSA

How well did you know this?

Not at all

Perfectly

Will a pt with a cutaneous abscess have systemic symptoms?

NOT usually but if present consider bacteremia

How well did you know this?

Not at all

Perfectly

What dx should you order in an cutaneous abscess? When would you order an xray?

dx are NOT necessary but can order US if you want to differentiate from cellulitis

if concerned about radiopaque FB or osteomyelitis

How well did you know this?

Not at all

Perfectly

What is the management of an cutaneous abscess?

(I&D) - requires informed consent

How well did you know this?

Not at all

Perfectly

What are the step by step procedure to I&D an abscess? When does the pt need to come back?

need to culture the pus to make sure the abx are approperiate

need to follow up in 2-3 days for packing removal or replacement

How well did you know this?

Not at all

Perfectly

What are the indications to rx abx after the abscess has been I&D?

Study These Flashcards

lesion > 2 cm
multiple abscesses
extensive surrounding cellulitis
immunosuppression or signs of systemic infection

What is the abx of choice for pt with cutaneous abscess? What about severe presentations, IC or signs of sepsis?

Study These Flashcards

PO: bactrim, doxy or clinda

severe:
IV vancomycin
Add cefepime or meropenem if signs of sepsis

What is the tx for a large/deep abscess?

drain in the OR

When do you need to consult a specialist in an abscess?

Consult specialist for abscesses affecting the: palms soles nasolabial folds or areas of cosmetic concern

What do you need to do first in a pt that is high risk for endocarditis and has an abscess?

Patients at high risk for endocarditis need abx prophylaxis prior to I&D¹ Abx given 60-120 minutes before incision bactrim, clinda, vanc, cefepime, meropenem (NOT doxy) are all appropriate choices

**What 2 questions should you ask your pt before draining an abscess to determine if they are a high risk for endocarditis or not?

**Any hx of heart valve problems? ** Any current or past hx of IV drug use?

What is the disposition for an abscess?

admit those who require IV abx everyone else can go home

What are the pt education wound care instructions for an abscess? **When do you need to return for a packing removal/change?

Wound care instructions - do not get wet, do not remove the dressing or packing Specific return precautions - “worsening in symptoms, fever, vomiting” **Return to ER or PCP in 2-3 days for packing removal/change

DVT of the UE extremity is usually due to _____

indwelling catheter

Unilateral extremity pain, swelling, or cramping +/- Erythema, warmth and tenderness + Homan's sign What am I? **What should you measure? What is a concerning finding?

DVT **A difference of ≥2 cm in diameter between right and left leg measured 10 cm below the tibial tubercle

What are 2 skin changes that would indicate a large PROXIMAL DVT?

Phlegmasia alba dolens Phlegmasia cerulea dolens

_____ swollen, painful, pale or white limb

Phlegmasia alba dolens

______ swollen, painful dusky or blue color limb

Phlegmasia cerulea dolens

What are the different scoring options for Well's for DVT score?

- Score of 0 or less - D-dimer - Score of 1-2 - high sensitivity d-dimer - Score of 3 or higher - US

What are some common causes of an elevated d-dimer?

thromboembolism: MI, stroke, acute limb ischemia, DVT, PE DIC Covid 19 severe infections sepsis sx/trauma liver dz kidney dz vascular disorders malignancy thrombolytic therapy pregnancy

What is considered a proximal vs distal DVT?

What are the absolute CI to anticoagulation in DVTs?

What is the tx for DVT w/o limb ishcemia?

DOAC(preferred) or LMWH/warfarin (alt.)

What is the tx for DVT with limb ishcemia or CI to anticoag?

consult vascular sx for surgical thrombectomy with IVC filter placement VS Catheter directed thrombolysis followed by anticoagulant (aka tPA directly into clot)

What are the admission criteria in a DVT?

Proximal DVT Concurrent symptomatic pulmonary embolism (PE) “High risk of bleeding” Comorbid conditions or other factors that warrant in-hospital care ______ renal insufficiency, hemodynamically unstable, social concerns ^ these were NOT directly stated the slides but inferred

What do you want to ask your DVT pt about before sending them home?

any s/s of chest pain or SOB? then these pts CANNOT go home because they potentially could be having a PE

claudication that is progressive over time atypical leg pain chronic non-healing wounds Hyperpigmented skin with hair loss What am I?

chronic PAD not an emergency

sudden onset, severe constant pain, doesn’t improve with rest What am I? What are the 6 Ps? Which ones are later to show up?

acute arterial occlusion pain (out of proportion) pallor poikilothermia (cold) _______ below are last to occur: paresthesias paralysis pulselessness

What is the progression of skin changes seen in arterial limb ischemia?

skin pallor, mottling/cyanosis, petechiae/blisters, necrosis

_____ is used to assess pulses at bedside in arterial limb ischemia along with ABI. What is abnormal? What is severe?

hand-held doppler <0.9 is abnormal <0.4 suggest severe disease

How do you calculate ABI?

_____ is the initial modality of choice for arterial limb ischemia. ______ is utilized if dx is uncertain after US or for presurgical planning

duplex US is initial CT angiography, MR angiography (Elkins said, CTA with "run off" into the legs)

Why do you want to get an EKG in a pt with arterial limb ischemia? What other non-routine labs would you want to order?

because of K, that could cause an new arrhythmias CK, myoglobin, lactic acid, UA

What are the major differences between the classifications of acute limb ischemia? What is the name of the scale?

I IIa IIb III **I and IIa have NO motor deficit and no/minimal sensory deficits (IIa) **IIb and III will have motor and sensory deficits

What is the management of stage I and IIa arterial limb ischemia?

Stage I and IIa: Perform diagnostic vascular imaging before treatment

What is the management of stage IIb arterial limb ischemia?

immediate consultation with vascular surgery about revascularization prior to additional diagnostic imaging

What is the management of stage III arterial limb ischemia?

irreversible damage and will likely require amputation

How will Elkins tell us the pt has weakness present in a question about arterial limb ischemia?

document the pt has strength 3/5 instead of strength is 5/5 bilateral like for a normal pt

What is the management of an arterial limb ischemia

Extremity Pain - Exam 3 Flashcards

(57 cards)