![]() In an austere environment, the elevation is the bit that you can do relatively easily – please don’t under-estimate how useful simple elevation can be. The body is good at dealing with an infection on a limb, but part of the infectious process is local swelling and the swelling can make it harder to treat. The specific treatment for cellulitis has two parts.įirstly, elevation to improve drainage of the area: Elevate the area, ideally above the level of the heart. If available simple pain relief like acetaminophen/paracetamol (+/- codeine) can be administered. In terms of general treatment, the patient should rest and stay hydrated – eating normal meals isn’t vital, but staying hydrated is and the patient should be encouraged to take a small amount of high energy food. It is caused by the bug Clostridium perfringes, from the same family of bugs that causes tetanus and botulism. In an austere situation, the only option is amputation before it spreads into the trunk. Treatment is surgical, with the removal of infectious tissue by cutting it away. But with gangrene, the infection is deeper into the muscles as well. Gangrene can involve the skin – it is often perceived as a black/purple congested looking limb, with a boundary on the skin slowly up moving up the limb. ![]() No, it isn’t – although there are some similarities. The presence of these suggests the infection is more established and more aggressive treatment is required. Sometimes the patient also has signs and symptoms of the infection moving more widely in the body – they may feel hot, have chills or shakes, be off their food and experience nausea or vomiting. It can be confused sometimes with a severe skin allergy, but the history of what happened usually gives it away. Classically it presents as it did in this man – an injury which damages the skin (although we do see it in apparently intact skin sometimes), after a day or so the area becomes hot, red, swollen and painful – over time (hours to days) it gets worse – more pain and worsening of the other symptoms. What is cellulitis?Ĭellulitis is an infection in the layers of the skin – the dermis and the epidermis. The pain increased and he was unable to move his wrist much due to pain or make a fist because of swelling in his fingers and palm. ![]() Over 12 hours the redness spread from the palm of his hand up onto the inner aspect of his wrist. After 36 hours, his hand started to hurt around the area of the wounds. He said that he easily pulled them out and washed his hand with clean fresh water and got on with his fishing. While landing a fish he grabbed hold of it with his hand and got several spines impaled in it. This patient was a 38-year-old man who had been fishing with friends three days before he came to the hospital. Patient 1: Cellulitis after a catfish spine jab 38 yr. What I plan to do over the next little while (and it might take a while to get through them!) is look at each patient in turn – how they presented, how easy it was to diagnose the problem and what are the options for diagnosis and treatment in an SHTF type scenario. On this night, I saw or supervised the care of the following 26 patients with these ultimate diagnoses: (problem, age, sex) I work in a regional ER serving a community of 200,000 people and I thought it might be interesting to look at the patients I saw, from an austere/survival medicine perspective, on a recent night shift.
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