ID3 - Osteopres
Terms in this set (25)
Joint infection Sxs
-Pain (sudden onset)
Joint infection Dx
Synovial WBC >50k
-Xray - tissue swelling, joint space narrowing, erosions, fat pad
*more useful than osteomyelitis
MC cause of joint infections, septic bursitis, and osteomyelitis
MC causes of prosthetic joint infections
What joint infection commonly comes with an associated rash?
*and requires a quick response
Joint infection Tx
-Abx based on pathogen
MSSA - IV nafcillin or oxacillin
-MRSA - IV vanco + rifampin
-Pseudomonas - IV ceftazidime
-Neisseria - IV ceftriaxone (Rocephin)
Septic bursitis Sxs
Fever + cellulitis = immediate aspiration
Olecranon and prepatellar
Three possible methods of osteomyelitis
*open fx, wound, surgical, bites
*abscess, diabetic foot ulcer, post op
*endocarditis, sepsis, UTI, IVDU, Pulmonary TB, Sickle Cell
Acute vs chronic osteomyelitis
-w/in 2 weeks-bacteria penetrates the bone causing abscess formation
--- deprives bone of
of the bone
- one to several months after bone infection
necrotic bone may remain infected and lead to
(causing non-healing draining wounds or sinuses)
Hx of acute osteomyelitisis big clue!
What system is the "gold standard" for pressure ulcer staging?
The National Pressure Ulcer Advisory Panel (NPUAP)*
Pressure ulcer staging
- intact skin with
-partial thickness loss of dermis
shallow open ulcer without slough
- full thickness tissue loss
subcutaneous fat may be visible
-full thickness tissue loss with
exposed bone, tendon, or muscle.
-Slough or eschar may be present.
- full thickness tissue loss that is
obscured by slough in the wound bed.
*Must be explored to determine stage.
Suspected Deep Tissue Injury (STDI)
due to damage of underlying tissue
* evolution may include a thin blister over a dark wound bed.
What system is typically used for staging diabetic (neuropathic) foot ulcers?
Wagner Grading System
Diabetic foot ulcer staging
* may have redness, callus or boney deformity.
- superficial, partial or full thickness ulcer
limited to the dermis
deep ulcer extending through the subcutaneous tissue
to tendon, joint or bone
*w/out osteomyelitis, abscess, or sepsis.
Deep ulcer with osteomyelitis, abscess, or joint sepsis
distinguishes between grade 2 and grade 3)
of the toes or forefoot .
- Foot with
MC location for osteomyelitis
Metaphases of long bones
-ESR (follow infection)
before Abx or 48 hrs after Abx stopped
-Xray - lytic lesions in 2-6 wks, periostitis, endosteal scalloping focal/diffuse osteolysis
-Bone/MRI/CT scan in 2 days
How long after stopping abx can you culture osteomyelitis?
-Staph aureus MC
-Coag neg staph
-Anaerobes in diabetic foot infections
others (usually in immunocompromised):
MUST debride/excise necrotic bone/tissue
(ensure adequate perfusion/oxygenation)
-MSSA - nafcillin or oxacillin
-MRSA - IV vanco
Nail through toe - cipro
-HBO if refractory
Poor osteomyelitis outcomes are common in these populations
-Any vascular disease
65 y/o m h/o DM type II uncontrolled and HTN.
Stepped on a nail.
Presented to ER 2 wks later.
Rad- air bubbles
Bacteria associated w/ air bubbles
Joint at highest risk for prosthetic joint infection
Prosthetic joint infection Sxs
W/in 6 mos of operation
Prosthetic joint infection Dx
-Xray - periostitis, endosteal scalloping focal/diffuse osteolysis
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