Soft Tissue Injuries: #3 Wound Infections

Cellulitis:

Recognition and Management of Cellulitis:
Monitor the wound site for the initial immune response to the multiplying bacteria.
Signs & Symptoms of a wound infection – cellulitis:
Initial:
Rubor:  The redness of the skin caused by the vasodilation.
Tumor:  Swelling of the soft tissue by the fluids that are escaping the dilated vasculature.
Dolor:  Pain caused by the swelling in the tissues.
Calor:  Warmth in the tissues from the vasodilation.
As the infection progresses:
Purulence: Pus formation, a collection of white blood cells (WBC’s) 
Lymphangina: red, tender streaks that progress up the extremity as the lymphatics become infected.
Lymphadenopathy: swollen, tender lymph nodes that occur when the infection reaches the lymph nodes proximal to the area of cellulitis.
If the infection reaches the central circulation, via the lymphatic drainage, then septic shock occurs with high fever, shaking rigors, tachycardia, and hypotension.

Treatment:
Hot water soaks of the area of cellulitis with non-scalding hot water and Epsom salts.  
The area of cellulitis should by heat soaked every 4 hours for at least 30 minutes, until the infection has resolved.  
If the infection continues to spread with lymphangina, lymphadenopathy, or purulence, consider an oral antibiotic such as penicillin, erythromycin, or trimethoprim/sulfamethoxazole (Bactrim).
Evacuate

For more detailed information on wilderness and long-term management of Soft Tissue Injuries see the Jan/Feb 2006 and the March/April 2006 issues of the Wilderness Medicine Newsletter.

This blog is powered by the Wilderness Medicine Newsletter, now celebrating 20 years of publication. The WMN is published and distributed online six times each year by TMC Books, and subscriptions cost as little as $10 per year. To find out more, or to subscribe online, click here.

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