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Emergency Medicine > Skin & Soft Tissue Disorders > Flashcards

Skin & Soft Tissue Disorders Flashcards

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1
Q

what is the MC pathogen present in dog/cat bites?

A

pasteurella

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2
Q

dog bites typically involve the ____ while cat bites involve _____

A

dog = face

cats = UEs

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3
Q

what is a major complication of a deep cat bite?

A

periosteum = osteomyelitis/septic arthritis

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4
Q

the below are three pathogens present in ____ bites

E. corrodens
GAS
staphylococcus

A

human bites

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5
Q

adult bites have a maxilary-intercanaine distance of…

A

> 2.5cm

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6
Q

Clean the surface of bites with…

A

povidone iodine

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7
Q

the below are indications for what intervention on bites/wounds?

deep wounds involving bone, tendon, joint, major structures

facial lac

neurovasc compromise

infx

A

surgical consult

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8
Q

The below require…

Deep puncture wounds

Moderate to severe wounds with associated crush injury

Underlying venous and or lymphatic compromise

Wounds on hands, genitalia, face or in close contact with bone/joint

Wounds requiring closure

Compromised hosts

A

prophylactic abx

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9
Q

Mgmt of plantar puncture… (4)

A

x-ray
cleansing
FB removal + closure
tetanus

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10
Q

Needle stick wound cleansing…

A

soap, water, alcohol

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11
Q

What is an important consideration of needle stick injuries?

A

HIV/HBV/HCV status

Post exposure prophylaxis

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12
Q

the below are indications for _______

•
Extension into sub Q
•
Decrease healing time
•
Reduce likelihood of infection
•
Decrease scar formation
•
Repair loss of structure or function
•
Improve cosmesis
A

wound closure

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13
Q

4 C/Is of closure

A

contamination
> 12 hrs
FB
tendon/nerve/artery involvement

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14
Q

What type of wound?

•
Surgical incisions
•
No involvement of GU, GI, respiratory
tracts
A

clean

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15
Q

What type of wound?

•
Involvement of GU, GI, respiratory tracts

A

clean-contaminated

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16
Q

What type of wound?

•
Gross spillage into surgical wound (bile,
stool)
•
Traumatic wounds
A

contaminated

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17
Q

What type of wound?

•
Established infection (I&D abscess)
•
Gross contamination

A

infected

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18
Q

What type of wound?

•
All layers closed
•
Best chance for minimal scarring
•
Clean/clean contaminated wounds
A

primary intention

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19
Q

What type of wound?

•
Deep layers closed
•
Superficial layers left to granulate
•
Can leave wide scar
•
Requires frequent wound care
A

secondary intention

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20
Q

What type of wound?

•
Deep layers closed primarily
•
Superficial layers closed in 4 5 days after
infection is not a concern
A

delayed primary intention

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21
Q

3 absorbable suture types…

A

vicryl

PDS

chromic gut

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22
Q

What type of suture?

absorbable
duration 6 mo

A

PDS

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23
Q

What type of suture

absorbable
duration 60-90 days

A

Vicryl

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24
Q

How long must sutures be dry?

A

48 hours

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25
signs of infx post-suture...
pain, swelling, redness, drainage
26
post-suture activity restriction?
PRN
27
analgesia post-suture...
OTCs
28
are prophylactic abx indicated for small, uncomplicated lacs?
no
29
2 important factors to decrease infx risk...
debridement | FB removal
30
shave before suturing?
no
31
most important means of decreasing infection risk
irrigation
32
What wounds need a re-check in 48-72 hours after closure?
highly contaminated wounds
33
In whom would absorbable sutures be favorable?
peds and elderly
34
Nonpurulent infection w.: ``` local pain swelling tenderness erythema warmth ```
cellulitis
35
The below are signs of what type of infx? ``` • Violaceous bullae • Cutaneous hemorrhage • Skin sloughing • Skin anesthesia • Rapid progression • Gas in tissue ```
severe deep tissue infx
36
3 considerations of outpatient management of cellulitis...
elevation empiric abx f/u 48-72 hours
37
The below are indications for ____ management of cellulitis Facial cellulitis of odontogenic origin Immunocompromised patients ``` Orbital cellulitis • Lymphedema • Cardiac, hepatic, or renal failure ``` Patient with comorbidities: Cellulitis affecting more than ¼ of an extremity
inpatient
38
which abx are mainstay of cellulitis tx?
amoxicillin, augmentin (beta lactams)
39
Which abx for cellulitis? strep or MRSA coverage
cephalaxin
40
Which abx for cellulitis? G- organisms
ceftriaxone
41
Which abx for cellulitis? no MRSA PCN allergy
macrolides (azithro, erythro, clarithro)
42
Which abx for cellulitis? Broad spectrum
FLQs (cipro, levo)
43
duration of tx for non-purulent cellulitis
5 days
44
Abx for mild cellulitis infection...(4)
PCN cephalosporin Diclox clinda
45
abx for moderate cellulitis infection
PCN Ceftriaxone cefazolin clinda
46
Tx for recurrent cellulitis (3-4 episodes a year)
PCN or erythro BID x 4-52 weeks
47
The below are at increased risk for what skin infx? staph carrier break in skin immunocompromised
abscess
48
the below are indications for what mgmt of abscess? ``` • Perirectal abscesses • Anterior and lateral neck abscesses • Hand abscesses • Abscesses adjacent to vital nerves or blood vessels • Breast abscesses near areola and nipple ```
surgical
49
abscess f/u
24-48 hours
50
how often to change packing in abscess?
q 24 hrs
51
if recurrent abscess/infx... what can be done?
daily chlorhexidine baths
52
MRSA decolonization procedure... (3)
BID nasal mupirocin QD chlorhexidine wash daily decon of personal items
53
MC burn wound infection...
staph aureus
54
mgmt of burn wound infx... (3)
avoid hypothermia Cx systemic abx
55
mgmt of MRSA burn wound infx
IV cefazolin/clinda/vanco
56
anesthetize before or after wound irrigation?
before
57
Necrotising fasciitis spares _______ tissue
spares muscle
58
pathogens of necrotising fasciitis...
polymicrobial aeurobes/anaerobes GAS or beta hemolytic strep
59
Infection of perineum involving scrotum...
fournier's gangrene
60
Patient p/w severe pain in anterior abd. wall migration to gluteal muscle, scrotum, penis
fournier's gangrene
61
On PE, you notice... ``` tense edema crepitus fever tachy hypotension ```
fournier's gangrene
62
Tx for fournier's gangrene...
dibridement, broad spectrum abx

Emergency Medicine (12 decks)

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