00:02
Okay, let's do a couple quick questions to review.
00:05
Remember, I'll ask a question,
you can pause the screen
and when you're ready to review the
answer, just unpause the screen.
00:11
So, question number one:
All of the following are common manifestations
of necrotizing fasciitis except:
Okay, number 1 - tenderness out
of proportion for the exam.
00:29
Yes, that's one of those classic pathognomonic features that
we'll see for necrotizing fasciitis on a board question.
00:35
Number 2 - well-demarcated borders.
00:38
That's definitely false.
00:40
Patients with necrotizing fasciitis
have edema deep in the dermis
and it can actually be very difficult to establish
where the borders of the infection are.
00:48
Number 3 - presence of crepitus.
00:50
Yes, you may see that with
any gas-producing organisms.
00:54
Number 4 - Bullous lesions are manifestations
that sometimes we do see necrotizing fasciitis
and absolutely you're gonna have systemic
signs and symptoms in such patients.
01:04
So our answer is that, well-demarcated borders are
not a common manifestation of necrotizing fasciitis.
01:11
Alright, our next and final question:
Which of the following is NOT an
appropriate antibiotic choice?
Okay, number 1 - mild impetigo.
01:28
Yup you can absolutely get by
with just topical mupirocin.
01:31
Number 2 - erysipelas with fevers and chills.
01:35
This sounds like a moderate to severe
case of a group A strep infection
an IV ceftriaxone would
definitely be appropriate
Next up, cellulitits with fevers and chills.
01:45
Well due to the increased prevalence
of methicillin-resistant Staph. aureus,
we would really need to use
IV vancomycin in this case.
01:52
Next up is suspected necrotizing fasciitis.
01:56
Well remember that with necrotizing fasciitis,
you need to use broad spectrum antibiotics.
02:01
You can't just get by with IV cephalexin.
02:04
You typically need to be able to treat against
potentially polymicrobial infections with staph,
strep, pseudomonas and a variety
of anaerobic bacteria as well.
02:12
Thus, such patients should get something more like
Vancozosyn plus clindamycin due to its antitoxin effects.
02:20
In addition, as I mentioned earlier,
the patient with suspected necrotizing fasciitis
is probably gonna require a surgical consultation to
debride any necrotic tissue and drain any fluid collections.
02:30
It's actually really quite a gruesome diagnosis.
02:34
Lastly, just to round things out with the mild cellulitis,
you can definitely get by with just oral Bactrim
which treats the majority of
community-acquired MRSA infections.
02:43
And with that, I think we've covered
all the bacterial skin infections.