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Cellulitis

  • Serious ddx

    • erysipelas, necrotizing fasciitis
    • SJS, toxic shock, SSS
  • Consider admission for

    • shock, SIRS or rapidly progressing
    • unable to elevate affected leg
    • unable to tolerate PO antibiotics
  • Admission orders

    • Admit: Floor
    • Diagnosis: Cellulitis
    • Condition: Stable
    • Vital Signs: Routine
    • Allergies:
    • Nursing: Dress abscess wounds with twice-daily wet-to-dry dressings
    • Diet: Regular
    • Activity: Elevate Affected Area When in Bed
    • Labs:
      • CBC, Chem, blood cultures x 2
      • CT if suspect orbital cellulitis
    • IV: Heplock IV
    • Special: surgical consult if concern for necrotizing fasciitis, orthopedic consult if loss of hand function
    • Medications:
      • if MSSA: Cefazolin 1.5 g IV q 8 hours (alternatives: Nafcillin, oxacilllin)
      • if penicillin allergy: Clindamycin
      • if MRSA: Vancomycin 1 g IV q 12 hours (alternatives: linozolid, daptomycin)
      • if animal/human bite: ampicillin-sulbactam
      • Ibuprofen 600 mg PO q 8 hours
      • Oxycodone 5-10 mg PO q 4 hours prn pain
      • Spectazole cream to both feet once daily
  • Discharge

    • criteria: transitioned to PO meds, fever, erythema reduced
    • education: prevention (foot care, elevation, compression hose, diuretics)
    • meds: Trimethoprim-sulfamethoxazole DS 2 tablets PO bid or doxycycline

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