Okay, let's do a couple quick questions to review.
Remember, I'll ask a question,
you can pause the screen
and when you're ready to review the
answer, just unpause the screen.
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.
Yes, that's one of those classic pathognomonic features that
we'll see for necrotizing fasciitis on a board question.
Number 2 - well-demarcated borders.
That's definitely false.
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.
Number 3 - presence of crepitus.
Yes, you may see that with
any gas-producing organisms.
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.
So our answer is that, well-demarcated borders are
not a common manifestation of necrotizing fasciitis.
Alright, our next and final question:
Which of the following is NOT an
appropriate antibiotic choice?
Okay, number 1 - mild impetigo.
Yup you can absolutely get by
with just topical mupirocin.
Number 2 - erysipelas with fevers and chills.
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.
Well due to the increased prevalence
of methicillin-resistant Staph. aureus,
we would really need to use
IV vancomycin in this case.
Next up is suspected necrotizing fasciitis.
Well remember that with necrotizing fasciitis,
you need to use broad spectrum antibiotics.
You can't just get by with IV cephalexin.
You typically need to be able to treat against
potentially polymicrobial infections with staph,
strep, pseudomonas and a variety
of anaerobic bacteria as well.
Thus, such patients should get something more like
Vancozosyn plus clindamycin due to its antitoxin effects.
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.
It's actually really quite a gruesome diagnosis.
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.
And with that, I think we've covered
all the bacterial skin infections.