So Im a 3rd yr EM res and I have seen a lot of practice variation over the years with cellulitis. Trying to find my comfort level with sending em home. What do you guys do?
Saw a17yr old pt recently with very uncomplicated finger cellulitis for 24hr with maybe 1 small area of streak up hand. No systemic stuff, nml vitals, nml labs, no outpt abx. She complained of a "strange feeling in her armpit." Attending was adamant that she be admitted for IV abx for "possible lymphangitis" Peds team was livid but took her for essentially 12 hrs and sent her home on clinda.
I have also seen our surgical service admit very benign looking stuff on the lower ext for nothing more than a days worth of vanc and an Id consult.
On the inpt side, ID tends to get consulted and rec PO abx very very soon, thus they always go home in no time flat.
To this point I guess I think that anything that looks really nasty in an at risk pt (old, DM etc) stays. Any VS abn' should probably stay, and any super young kid should stay.
Pretty much everything else I feel should get a shot at outpt PO abx (keflex/bacrim, doxy, or clinda) and FU/return instructions. But this seems to be a grey area.
What do you guys do?
Saw a17yr old pt recently with very uncomplicated finger cellulitis for 24hr with maybe 1 small area of streak up hand. No systemic stuff, nml vitals, nml labs, no outpt abx. She complained of a "strange feeling in her armpit." Attending was adamant that she be admitted for IV abx for "possible lymphangitis" Peds team was livid but took her for essentially 12 hrs and sent her home on clinda.
I have also seen our surgical service admit very benign looking stuff on the lower ext for nothing more than a days worth of vanc and an Id consult.
On the inpt side, ID tends to get consulted and rec PO abx very very soon, thus they always go home in no time flat.
To this point I guess I think that anything that looks really nasty in an at risk pt (old, DM etc) stays. Any VS abn' should probably stay, and any super young kid should stay.
Pretty much everything else I feel should get a shot at outpt PO abx (keflex/bacrim, doxy, or clinda) and FU/return instructions. But this seems to be a grey area.
What do you guys do?