IDSA – image if febrile neut + cellulitis; blood cultures if highly immunocompromised, systemic toxic effects or animal bites. Blood culture: on chemo, neutropenia, severe cell-mediated immunodeficiency, immersion injuries
What's Hot in Emergency Medicine June 2018
What’s hot in EM?
Dr F Morris
• Hot legs
– Imaging and blood cultures in cellulitis
• Clot disposal
– PE pathway 2018
• Recognising the deteriorating sepsis guideline
• Haematologists party hard
– Anticoagulant nomenclature
“Let’s get some pictures of that leg”
• Retrospective cohort study
• Oct 2014 – Feb 2017
• n = 183 “uncomplicated cellulitis”
– Admitted to medics or EDU.
– 60 had blood cultures – 1 positive growth
• 18/183 were appropriate by IDSA guidelines.
– 124 had imaging:
• 83 had 1 form; 30 had 2 forms; 11 had 3 or more forms.
• All were inappropriate by IDSA guidelines.
• Higher proportion of chronic lymphoedema and
Ko LN et al. Clinical usefulness of imaging and blood cultures in cellulitis evaluation. JAMA Intern Med 2018 Apr
Stevens et al. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases
Society of America. Clinical Infectious Diseases, Volume 59, Issue 2, 15 July 2014
Clinical Resources Efficiency Support Team (CREST). Guidelines on the management of cellulitis in adults. June 2005
International Society on Thrombosis &
Barnes GD, Ageno W, Ansell J, Kaatz S, for the Subcommittee on the Control of Anticoagulation. Recommendation on the nomenclature for
oral anticoagulants: communication from the SSC of the ISTH. J Thromb Haemost 2015; 13: 1154–6.
• Think about your tests in cellulitis
• New PE pathway (via scghed.com)
• Sepsis is still causing a fuss
• We can still use the term NOAC