Zephiah Brissett

The first patient you are asked to see is a 78 year old gentleman with right lower leg pain and feeling unwell, no fever, just tiredness last 2 days, the right leg seems sore and painful but not sure why as he has had no accidents, falls or trauma. It was an acute onset of red, painful, hot swollen and tender skin and has spread over the last few days.

Pmh- Hypertension and Diabetes type 2 on insulin. No allergies.

On Examination

Temp 37.9 pulse 78 reg, sats 99% in air, BM-15.8, rr-16. BP 134/82.

Some calf pain, redness and heat.

There is a small lesion on the back of the leg – insect bite? ulcer? it is weeping pus?

When examining Zephiah

Look for a skin break where the infection organism may have entered, such as a wound, macerated skin, fungal skin infection or an ulcer.

Categorise the severity of cellulitis:

The Eron classification system can help guide admission and treatment decisions.

• Class I – There is no signs of systemic toxicity and the person has no uncontrolable comorbidities

• Class II – The person is either systemically unwell or systematiuclly well but with comorbidities (for example peripheral arterial disease, chronic venous insufficient, or morbid obesity) which may complicate or delay resolution of infection.

• Class III – The person had a significant systemic upset such as acute confusion, tachycardia, tachypnoea hypertension, or unstable comorbidities, or unstable comorbidities that may interfere with a response to treatment, or a limb-threatening infection due to vascular compromise.

• Class IV – The person had sepsis syndrome or a severe life-threatening infection such as necrotizing fasciitis.

For Zephiah the cellulitis is class 2. In your documentation write up your consultation – including management would be.