Episode 69 – Cellulitis and Other Skin and Soft Tissue Infections

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 2022Episode Outline:1. Why cellulitis/skin infections?2. TerminologyErysipelas vs cellulitis vs fasciitisPurulent cellulitis3. Most common pathogens4. Special situations5. Necrotizing infection classification system – is this helpful in the ED, and if so, why?6. Differential – unilateral vs bilateral presentation7. Prehospital care8. ED evaluationHistory – what should we be asking?Examination: SSTI vs NSTI9. DiagnosticsPOCUS: “cobblestoning” and fluid collectionXray: subcutaneous gasCT: when is this helpful?10. LabsBlood 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