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 2022

Episode Outline:

1. Why cellulitis/skin infections?

2. Terminology

• Erysipelas vs cellulitis vs fasciitis
• Purulent cellulitis

3. Most common pathogens

4. Special situations

5. Necrotizing infection classification system – is this helpful in the ED, and if so, why?

6. Differential – unilateral vs bilateral presentation

7. Prehospital care

8. ED evaluation

• History – what should we be asking?
• Examination: SSTI vs NSTI

9. Diagnostics

• POCUS: “cobblestoning” and fluid collection
• Xray: subcutaneous gas
• CT: when is this helpful?

10. Labs

• Blood 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