Emergency Department Management of Cellulitis and Other Skin and Soft-Tissue Infection (Infectious Disease CME and Pharmacology CME) | Store
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Emergency Department Management of Cellulitis and Other Skin and Soft-Tissue Infection (Infectious Disease CME and Pharmacology CME) -
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Emergency Department Management of Cellulitis and Other Skin and Soft-Tissue Infection (Infectious Disease CME and Pharmacology CME)
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Publication Date: May 2022 (Volume 24, Number 5)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 05/01/2025.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Infectious Disease CME credits and 1 Pharmacology CME credit, subject to your state and institutional approval.

Authors

Kyle Howarth, MD
Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX
Joby Thoppil, MD, PhD
Assistant Professor of Emergency Medicine, Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX
Gilberto A. Salazar, MD, FACEP, DABEMS
Associate Professor of Emergency Medicine; Department of Emergency Medicine; Section Director, EMS Education, University of Texas Southwestern Medical Center, Dallas, TX

Peer Reviewers

Marc Kanter, MD
Associate Chief and Residency Program Director, Department of Emergency Medicine, Lincoln Medical & Mental Health Center, Bronx, NY
Jennifer White, MD
Associate Professor, Director of Clinical Operations, Thomas Jefferson University Hospital Center City, Philadelphia, PA

Abstract

Cellulitis and other skin and soft-tissue infections (SSTIs) are common presentations in the emergency department. This review describes the varied etiologies and patient presentations of the more common SSTIs: cellulitis, abscesses, and necrotizing soft-tissue infections. A discussion of the common diagnoses masquerading as SSTIs is presented, as well as a stepwise approach to avoiding misdiagnosis. Diagnostic studies are also evaluated, including discussions on ultrasound, computed tomography, and clinical decision rules. This review also provides an evidence-based analysis of the controversies in management of abscesses, including the commonly utilized techniques of incision and drainage, irrigation, packing, and concurrent antibiotic therapy.

Case Presentations

CASE 1
A 35-year-old man presents with a 3-cm circular, slightly raised lesion on his left lower leg that has associated warmth, erythema, and tenderness…
  • The patient reports that the lesion appeared 2 days ago, and that he has had similar-appearing lesions in the past.
  • He is afebrile and hemodynamically stable, but he said this lesion is causing him moderate discomfort.
  • You are concerned for an abscess but are unsure whether there is a significant fluid pocket. What imaging modality can you utilize to confirm your diagnosis at the bedside? What should your management of this patient’s presentation include?
CASE 2
A 72-year-old man with a past medical history of diabetes, obesity, chronic obstructive pulmonary disease, and coronary artery disease presents with vague complaints of malaise and generalized weakness…
  • Point-of-care glucose in triage was 402 mg/dL. Presenting vital signs were: heart rate, 88 beats/min; temperature, 37.6ºC; respiratory rate, 16 breaths/min; and oxygen saturation, 97% on room air.
  • On examination, his lungs are clear to auscultation, no murmurs are present, and his abdomen is soft and nontender.
  • No obvious source of infection is initially apparent on exam, and you begin to exit the room, planning an extensive diagnostic workup. Before leaving, you ask him to undress completely, and you notice that his scrotum and perineum are erythematous, necrotic, with a foul odor and purulent discharge. Given this presentation, what is your immediate concern? What, if any, immediate medical management should be started? Should you call your consultant immediately or wait for labs and imaging to return?
CASE 3
A 38-year-old woman with a past medical history of ulcerative colitis presents with isolated swelling, warmth, and significant tenderness with range of motion to the right hand and wrist…
  • She reports that she had a similar occurrence to her other hand 2 months ago. At that time, she was diagnosed with cellulitis and treated with a course of antibiotics, but her symptoms did not improve for some time. She denies any trauma to the area.
  • The patient is afebrile and hemodynamically stable.
  • Is this patient presenting with a repeat occurrence of cellulitis? What procedure could be performed to better investigate the etiology of this patient’s pain?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

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