In this episode, Sam Ashoo, MD interviews Kyle Howarth, MD and Joby Thoppil, MD, PhD – two of the authors of the May, 2022 EMP article on Cellulitis and Skin and Soft Tissue Infections. Listen to the discussion to hear more about the emergency department management of cellulitis and necrotizing skin infections.
Episode 69 – Emergency Department Management of Cellulitis and Other Skin and Soft-Tissue Infections (https://www.ebmedicine.net/topics/infectious-disease/emergency-medicine-skin)
EMplify – May 2022
Episode Outline:
1. Why cellulitis/skin infections?
2. Terminology
- Erysipelas vs cellulitis vs fasciitis
- Purulent cellulitis
3. Most common pathogens
4. Special situations
5. Necrotizing infection classification system – is this helpful in the ED, and if so, why?
6. Differential – unilateral vs bilateral presentation
7. Prehospital care
8. ED evaluation
- History – what should we be asking?
- Examination: SSTI vs NSTI
9. Diagnostics
- POCUS: “cobblestoning” and fluid collection
- Xray: subcutaneous gas
- CT: when is this helpful?
10. Labs
- Blood cultures – if given the option, are they helpful?
- Wound cultures – any role for these?
- Routine labs (CBC, BMP, etc) – are they helpful?
- LRINEC score – what is it and should we be using it?
11. Treatment
- NSTI antibiotics
- Abscesses
12. Special populations
- IV drug users
- Diabetic patients
- Immunocompromised patients
13. Wound irrigation and loop drainage
14. Disposition
Last Updated on January 25, 2023
Good .
More discussion of primary care soft tissue infection – medication and length of treatment is seven days enough in 99% of cases ?
Also not mention of the value of baseline CRP or ESR or temperature pulse rate blood pressure sitting and standing .
Hi Ian, thanks for listening. There is a good summary of treatment including specific antibiotics and duration in the tables of the article. We touched on them briefly during the conversation. It’s a great article and I recommend reading all of it. Check it out: https://www.ebmedicine.net/topics/infectious-disease/emergency-medicine-skin