Kufalikira kwa Cellulitis, Red Lymphangitis Streaks, ndi Zadzidzidzi Zadzidzidzi za Khungu¶

Matenda owopsa a pakhungu la bakiteriya ndi minofu yofewa (SSTIs) amayambira kuphatikizika kwa mafinya (zithupsa, zithupsa, ndi ma carbuncles) kupita ku matenda omwe amafalikira mwachangu pakhungu ndi subcutaneous (erysipelas, cellulitis, ndi acute ascending lymphangitis). Ngakhale kuti matenda ambiri a pakhungu amakhudzidwa ndi maantibayotiki kapena madzi osavuta, matenda a pakhungu omwe amafalikira mofulumira ola ndi ola, amatumiza mikwingwirima yofiira pa mkono kapena mwendo mpaka kukhwapa kapena groin, amawombera pakati pa nkhope kapena mphuno ya diso, kapena kuyambitsa kutentha kwa thupi, kuzizira, chisokonezo, kapena kupuma mofulumira kungapitirire m'maola ochepa kuti ayambe matenda owopsa a magazi (sepsis ndi septic shock) kapena kudya nyama necrotizing fasciitis. Ngati chimodzi mwa zizindikiro zoopsazi chikuwoneka, imbani foni m'dera lanu manambala angozi kapena pitani kuchipatala chapafupi chapafupi mwamsanga. Onaninso maupangiri athu pa orbital cellulitis ndi matenda owopsa pamakona atatu ndi Deep vein thrombosis (DVT).

Zomwe mukuchita kunyumba ndi **kufufuza malire enieni akunja kwa redness ndi cholembera cha inki ndikulemba nthawi ya wotchi pakhungu **, kukweza mwendo wotupa pamwamba pamtima kuti muchepetse edema yotupa, **osafinya, pop, kapena singano chithupsa kapena chiphuphu kunyumba **, ndipo fufuzani nthawi yomweyo kuchipatala ngati zizindikiro zowopsa za lymphatic system.

Chitani izi tsopano¶

1. Yang'anani nthawi yomweyo kuti muwone mbendera zofiira za Sepsis kapena Necrotizing Fasciitis zomwe zikuwopseza moyo ndipo imbani nambala yanu yazadzidzi yapafupi ngati ilipo. Imbani 911 ku United States ndi Canada, 112 kudutsa European Union, 999 ku United Kingdom, 000 ku Australia, kapena onani chikwatu chathu cha manambala angozi ngati munthuyo ayamba kuwawa kopambanitsa molingana ndi momwe khungu limawonekera, matuza ofiirira-wakuda (bullae), khungu lomwe limamveka ngati buluu (crepitus) kapena kupita dzanzi kwathunthu, kusokonezeka kapena kugona, kupuma mwachangu (kupuma kopitilira 22 pamphindi), kunjenjemera (kuuma), kapena kuthamanga kwa magazi.
2. Gwiritsani ntchito cholembera kapena cholembera pochita opaleshoni kuti muwone m'mphepete mwa khungu lofiira ndikulemba nthawi yeniyeni yomwe ili pafupi ndi mzerewo. Lembani pang'onopang'ono mzere wodutsa kapena wolimba m'mphepete pomwe khungu lofiira ndi lofunda limakumana ndi khungu labwinobwino, ndipo lembani nthawi (mwachitsanzo, 14:30). Inu kapena dokotala mukayang'ananso khungu patatha maola 1 mpaka 2, kufiira kulikonse komwe kumadutsa mu inki yanu kumatsimikizira kuti matendawa akufalikira ndipo amathandizira kuyeza momwe akuyendera.
3. **Yang'anani mizere yofiira (mikwingwirima ya lymphangitis) yoyenda m'mbali ndi kumamva kutupa, ma lymph nodes kukhwapa, chigongono, kapena groin. Ascending lymphangitis amatanthauza mabakiteriya owopsa (ambiri a Streptococcus pyogenes) alowa m'mitsempha yamagazi ndipo akuthamangira m'magazi apakati; Izi zimafuna kuunika kwachipatala mwachangu komanso nthawi zambiri kulowetsa maantibayotiki.
4. OSAFINYA, kutsina, kutulutsa, kapena kubandika singano kapena lumo pa chithupsa, pimple, kapena pakhungu. Kufinya chiphuphu kumapangitsa kuti khoma lotupa losalimba (pyogenic membrane) lozungulira thumba la mafinya liphwanyike, kuswa mafinya** chakumbuyo ndi kuzama**, kulowa m'mitsempha yamagazi, m'mitsempha yamagazi. Staphylococcus aureus wosamva methicillin* (MRSA) molunjika m'magazi (**bacteremia, endocarditis, kapena cavernous sinus thrombosis **).
5. Kwezani chiwalo chokhala ndi cellulitis yosavutikira pamwamba pamlingo wamtima (pokhapokha ngati akuganiziridwa kuti ali ndi matenda a arterial kapena compartment syndrome). Kukweza mwendo kapena mkono wokhala ndi cellulitis mmwamba pamapilo pamwamba pa mtima kumagwiritsa ntchito mphamvu yokoka kukhetsa madzi otupa (edema), omwe amachepetsa kupweteka kwa khungu ndikuthandizira maantibayotiki kulowa m'kati mwa minofu.
6. Pakani compress yoyera, yonyezimira pa chithupsa chotsekeka chapafupi (kapena nsalu yonyowa yoziziritsa ku hot erysipelas/cellulitis) ndikuchotsa mphete zonse, mawotchi, ndi nsapato zothina. Chotsani mphete iliyonse pazanja lotupa kapena chala chotupa nthawi yomweyo kutupa kusanatseke chitsulo ndi kukokera manambala. Kwa chithupsa chapafupi, chotchingidwa ndi mipanda popanda matenda, kupumitsa nsalu yochapira yofunda kwa mphindi 15 katatu mpaka kanayi tsiku lililonse kumawonjezera kutuluka kwa magazi mpaka dokotala atha kupanga kucheka ndi kukhetsa madzi (I&D).

Mtengo wosankha: triaging pachimake redness khungu, red mikwingwirima, ndi mafinya abscesses¶

flowchart TD
    Start["Pakhungu Lofiyira, Kutentha, Kutupa, Kapena Kupweteka Pakhungu (Kufalikira Kufiyira, Zotupa Zokwera, Mikwingwirima Yofiyira, kapena Chithupsa cha Mafinya)"] --> CheckDeadly{"Khwerero 1: Yang'anani Opaleshoni Yofiira & Sepsis Mbendera Zofiira: Kupweteka kosawerengeka, matuza ofiirira / akuda, dzanzi, crepitus, chisokonezo, kupuma mofulumira, kuzizira, kapena kutupa kwa maso / khosi / perineal?"}

    CheckDeadly -->|"INDE ku Red Flag ILIYONSE"| Emergency911["ZOCHITIKA MOYO- KAPENA MIYEZO-ZOYAMBIRA: Imbani 911 / 112 / 999 kapena Pitani ku Dipatimenti Yodzidzimutsa Zachipatala Nthawi yomweyo (Suspect Necrotizing Fasciitis, Sepsis, kapena Orbital Cellulitis)"]

    CheckDeadly -->|"AYI: Chenjezo, zofunikira zokhazikika, mtundu wamba wapinki/wofiira"| PenMark["Khwerero 2: Jambulani Border Ink Cholembera Kuzungulira Kunja kwa Kufiyira ndi Lembani Nthawi Yeniyeni Yeniyeni ya Wotchi Pakhungu; Chotsani mphete Zonse ndi Mawotchi"]

    PenMark --> Classify{"Khwerero 3: Ndi Matenda Amtundu Wanji Pakhungu Alipo?"}

    Classify -->|"Mizere yofiira (mikwingwirima) yoyenda mmwamba mkono kapena mwendo kupita kukhwapa kapena ma lymph nodes"| Lymphangitis["ACUTE ASCENDING LYMPHANGITIS: Pitani ku Dipatimenti Yazadzidzi kapena Chisamaliro Chachangu pasanathe maola angapo kuti mukalandire maantibayotiki (nthawi zambiri a IV) mabakiteriya asanachitike."]

    Classify -->|"Zolemba zathyathyathya kapena zokwezeka zowotcha zofiira (Cellulitis kapena Erysipelas - Palibe thumba la mafinya)"| Cellulitis["CELLULITIS KAPENA ERYSIPELAS: Kwezani mwendo pamwamba pamtima, fufuzani pakati pa zala za ming'alu ya mafangasi, fufuzani tsiku lomwelo kuwunika kwachipatala; pitani ku ED nthawi yomweyo ngati kufiira kumadutsa cholembera mwachangu kapena kutentha thupi kumayamba"]

    Classify -->|"Thumba lokhala ngati dome kapena thumba la mafinya (Cutaneous Abscess, Furuncle, kapena Carbuncle)"| Abscess["ZOPHUNZITSA ZABWINO / CHITHUNZI: OSAFINYA, POPANDA, kapena kuboola singano kunyumba; ikani compress yotentha yoyera ndikuwonana ndi sing'anga wa sterile Incision and Drainage (I&D) kuphatikiza maantibayotiki a MRSA"]

Gulu lachipatala: cellulitis vs. erysipelas vs. lymphangitis vs.¶

Malinga ndi Infectious Diseases Society of America (IDSA) ndi ** UK National Institute for Health and Care Excellence (NICE)** malangizo pa khungu ndi minofu yofewa, chithandizo chadzidzidzi chimadalira ngati matendawa ndi ** osakhala purulent ** (kufalitsa kutupa kofalikira kudzera mu dermis kapena lymphatics popanda thumba la pus, lomwe nthawi zambiri limayambitsidwa ndi Stre-purumoccus) (kutoleredwa kwa mafinya otchingidwa ndi mipanda mkati mwa dermis kapena mafuta ocheperako, oyambitsidwa kwambiri ndi Staphylococcus aureus, kuphatikiza MRSA yotengedwa ndi anthu).

Momwe ndimomwe mungapangire njira ya "Pen Border ndi Timestamp".¶

Pamene wodwala kapena wachibale akuyang'ana mwendo wofiira, kutupa kapena mkono, kukumbukira kwaumunthu sikungathe kuweruza modalirika ngati kufiira kwakula ndi 1 centimeter kapena 5 centimita pa maola atatu apitawa, makamaka posintha kuwala kwa chipinda. Madokotala azadzidzi, anamwino, ndi dermatologists padziko lonse lapansi amagwiritsa ntchito **Ink Pen Demarcation Njira **:

1. Gwiritsani ntchito cholembera chanthawi zonse, cholembera nsonga bwino, kapena cholembera chapakhungu: Sambani m'manja ndi sopo kaye. Jambulani mizera yayifupi pang'ono kapena mzere wopitilira m'mphepete mwakunja kwenikweni* kwa kufiyira kowonekera (erythema). Ngati pali mizere yofiira ya lymphangitic yomwe ikuthamanga m'manja kapena mwendo, jambulani mzere wawufupi wodutsa pa nsonga yapamwamba kwambiri ya mzere wofiira.
2. Lembani nthawi yeniyeni (ndi tsiku) pakhungu lathanzi pafupi ndi mzerewu: Mwachitsanzo, lembani 10:00 AM kapena 10:00.
3. Mmene mungatanthauzire zosintha kudutsa mzere wolembera:
4. Kukula msanga MUSANAyambe mankhwala opha maantibayotiki: Ngati kufiira kukukulirakulira kupitilira 1 mpaka 2 centimita pa ola kudutsa inki yanu, kapena ngati mzere wofiira wa lymphangitic ukukwera mainchesi angapo mmwamba pa mkono kapena ntchafu mkati mwa maola 1 mpaka 2, kuchuluka kwa bakiteriya kapena kupanga poizoni kukuyenda mwachangu; pitani kuchipatala chachipatala mwamsanga.
5. The "First 24-to-48-Hour Antibiotic Paradox" (Jarisch-Herxheimer-ngati inflammatory flare): Malinga ndi IDSA ndi malangizo a NICE, wodwala akangoyamba kumwa mankhwala oyenerera am'kamwa kapena m'mitsempha a cellulitis, kufiira ndi kutupa pafupipafupi klzzwxh:0042 pa mzere womba wa 24. Izi zimachitika chifukwa maantibayotiki amapha mamiliyoni a mabakiteriya a Streptococcal pakhungu, makoma a bakiteriya ophulika amatulutsa poizoni ndi ma antigen omwe amapeza kwakanthawi maselo oyera amagazi ndi madzimadzi m'mphepete mwa chotupacho. Malingana ngati wodwalayo akumva kuti ali wokhazikika (palibe kutentha kwatsopano kwatsopano, kuzizira, kapena kupweteka kwakukulu), kukulitsa malire ang'onoang'ono m'maola oyambirira a 24 sikutanthauza ** osati ** kutanthauza kuti antibiotic yalephera; komabe, ngati kufiira kukupitirirabe kukula maola 48 apitawo mpaka 72 a mankhwala opha maantibayotiki, kapena ngati zizindikiro za machitidwe zikuipiraipira nthawi ina iliyonse, kuwunikanso kwachipatala mwachangu ndikofunikira.

Acute lymphangitis: chifukwa chiyani "kukwapula kofiyira" molunjika kukhwapa kapena groin ndi ngozi yachipatala¶

M'nthano zodziwika bwino, mzere wofiira wokwera pamkono kapena mwendo kuchokera m'madula omwe ali ndi kachilombo nthawi zambiri molakwika amatchedwa "kupha magazi." Mwachizoloŵezi, mzere wofiira umenewo ndi acute ascending lymphangitis: kuukira kwa bakiteriya ku lymphatic channel komwe kumachotsa madzi amadzi kuchokera pakhungu kubwerera kumtima.

Momwe mabakiteriya amayendera kuchokera pakhungu laling'ono kulowa m'magazi¶

1. ** Khomo lolowera:** Nthawi zambiri bala loyambira limakhala laling'ono modabwitsa: kukwapula kwa mphaka kapena kuluma padzanja, minga ya rozi, matuza pachidendene, chikhadabo chodwala (paronychia), kulumidwa ndi udzudzu kapena kangaude komwe kumakandwa ndi zikhadabo, kapena kusweka kwakhungu pakati pa phazi* ndi phazi.
2. Kuukira kwa ma lymphatic capillaries: Mabakiteriya owopsa (odziwika kwambiri Gulu A Streptococcus pyogenes, omwe amatulutsa ma enzymes osungunula minofu monga hyaluronidase ndi streptokinase, kapena Pasteurella multocida mkati mwa maola 12 mpaka 24 a microscopic lymphocytes amalowa mkati mwa maola 12 mpaka 24) khungu.
3. Mikwingwirima yofiira yowoneka m'mizere ya ma lymphatic: Pamene mabakiteriya akuchulukirachulukira ndikumakwera m'mwamba mkati mwa mitsempha yowoneka bwino yomwe ikuyenda motsatira mitsempha ya mkono kapena kumunsi kwa mwendo, makoma a mitsempha ya m'mitsempha imayaka kwambiri ndikukulitsa ma capillaries omwe ali pamwamba, kujambula **mzere umodzi kapena kuposerapo kutenthetsa.
4. Zotchinga zam'dera la lymph node (Lymphadenitis): Mitsempha yamagazi imanyamula mabakiteriya kupita kumalo osefera amchigawo: epitrochlear node mkati mwa chigongono chamkati ndi axillary node m'khwapa (pa matenda a m'manja/mkono), kapena popliteal node kuseri kwa bondo*** kuseri kwa bondo* matenda a mapazi/miyendo). Ma lymph nodes amenewa amasanduka mfundo zopweteka komanso zanthete pamene maselo oteteza thupi ku matenda amalimbana kuti agwire mabakiteriyawo.
5. Kudutsa mu thoracic duct ndi vena cava (Bacteremia ndi Sepsis): Ngati matendawa achulukitsitsa ma lymph nodes popanda mankhwala opha maantibayotiki, kachilomboka kamalowera ku ** thoracic duct** (kapena kumanja kwa lymphatic duct) ndikuthira molunjika mu subclavian vein pamwamba pa mtima* mabakiteriya amoyo* amasefukira ndi mabakiteriya amoyo*. kuyambitsa septic shock mkati mwa maola angapo.

Ziphuphu zam'mimba ndi zithupsa za MRSA: chifukwa chiyani kufinya kapena kupumira kunyumba ndizowopsa¶

Chiphuphu chapakhungu ndi chiphuphu cha mafinya (maselo oyera amagazi akufa, zinyalala za minofu yamadzimadzi, ndi mabakiteriya amoyo) wozunguliridwa ndi khoma la vascularized fibrin yotupa ndi minofu ya granulation. A furuncle (chithupsa) ndi chiphuphu chomwe chimayambira mkati mwa follicle ya tsitsi, pomwe carbuncle ndi gulu lakuya, lamitundu yambiri la zithupsa zolumikizana zomwe zimapanga zithupsa zazikulu, zolimba, zolimba (zambiri pakhosi, msana wammbuyo, kapena ntchafu mwa akulu akulu kapena anthu omwe ali ndi matenda ashuga).

Chifukwa chiyani simuyenera kufinya kapena kutulutsa chithupsa kunyumba¶

Chithupsa chikatupa ndi kupweteka, odwala nthawi zambiri amayesa kutsina ndi kufinya pakati pa zala zawo ngati ziphuphu zakumaso, kapena kuzibaya ndi singano yosokera yoyaka moto kapena mpeni.

Momwe asing'anga amachizira chithupsa motetezeka: Kudula ndi Kukhetsa (I&D)¶

Maantibayotiki okha sangathe kuchiza abscess okhwima chifukwa avascular pabowo la acidic mafinya alibe mitsempha kunyamula mankhwala mkati, ndi otsika pH deactivates ambiri mankhwala. Kuchipatala chachangu kapena dipatimenti yazadzidzidzi, sing'anga amachita mwachangu ** Incision and Drainage (I&D): - Pambuyo poyeretsa khungu ndi kuwaza dome ndi lidocaine (ndipo nthawi zambiri amayang'ana mthumba ndi ** ultrasound ultrasound kuti atsimikizire kuti ndi chiphuphu chamadzimadzi m'malo molimba kwambiri kapena pseudoaneurysm pamwamba pa mtsempha wamagazi), dokotala amapanga mzere wodutsa pamtunda wosinthasintha ndi scalpel wosabala kotero kuti mafinya amatuluka momasuka. - Dotolo amasesa pang'onopang'ono hemostat kapena curette m'kati mwake kuti athyole matumba a ulusi wamkati (**malo ) momwe mafinya amabisala, amatsuka pabowo ndi saline wosabala, ndikuyika chingwe chopepuka ngati pakufunika kuti m'mphepete mwa khungu musatseke msanga. - Pa ** malangizo a IDSA, kuwonjezera pakamwa MRSA-active antibiotic (monga trimethoprim-sulfamethoxazole [Bactrim/Septra] kapena doxycycline) kwa masiku 5 mpaka 10 pamodzi ndi I&D kumapangitsa kuti machiritso achiritse komanso amachepetsa zithupsa zobwerezabwereza, ndipo zimafunikira nthawi iliyonse pakadutsa chithupsa. cellulitis, yomwe ili pa nkhope / dzanja / maliseche, kapena imapezeka mwa wodwala malungo, matenda a shuga, kapena kuponderezedwa kwa chitetezo cha mthupi.

Kuzindikira kosiyana kwakukulu: mikhalidwe yomwe imawoneka ngati cellulitis (kapena kubisala pansi pake)¶

Tsiku lililonse pachipatala chadzidzidzi, misampha iwiri yosiyana yodziwira matenda imachitika: mwina opaleshoni yoopsa (** necrotizing fasciitis ** kapena **deep vein thrombosis **) imachotsedwa ngati "cellulitis yosavuta," kapena matenda osapatsirana a mwendo (**venous stasis dermatitis **, kuwerengera mpaka 30 peresenti ya "missing legly" yofunikira mobwerezabwereza) mankhwala opha tizilombo.

Malo apadera omwe ali pachiwopsezo chachikulu: kulumidwa ndi nyama, kuwonekera pamadzi, ndi ming'alu ya phazi¶

Nthawi zonse mukafuna chithandizo chamankhwala a cellulitis kapena chiphuphu, **nthawi zonse muwuzeni adokotala momwe khungu linasweka komanso malo omwe adakhudza bala **, chifukwa mawonekedwe apadera amakhala ndi mabakiteriya achilendo omwe sagonjetsedwa kwathunthu ndi maantibayotiki a cellulitis (monga cephalexin kapena penicillin):

1. Kulumidwa kwa Amphaka ndi Agalu (Pasteurella multocida ndi Capnocytophaga): Mano amphaka amakhala ngati singano zomwe zimabaya Pasteurella multocida mozama m'mitsempha yamanja ndi m'malo olumikizirana mafupa, zomwe zimayambitsa kuphulika kwa cellulitis ndi lymphangitis mkati mwa 12 mpaka 24 hours* (onani kuluma kwa nyama). Imafunika amoxicillin-clavulanate (Augmentin) osati cephalexin. Capnocytophaga canimorsus kuchokera ku malovu agalu angayambitse fulminant sepsis mwa odwala opanda ndulu (kutupa kwa splenic ndi asplenia) kapena matenda a chiwindi.
2. Madzi amchere, Madzi a Brackish (Gulf of Mexico / Coastal Estuaries), kapena Raw Shellfish (Vibrio vulnificus): Ngati kudulidwa, kukwapula, kapena mbedza kukakhala m'madzi otentha a m'mphepete mwa nyanja (monga Gulf of Mexico) kapena oyster yaiwisi, Vibrio vulnificus angayambitse vuto la hemorrhagic bullous cellulitis ndi necrotizing fasciitis mkati mwa **12 mpaka 24 maola, anthu omwe ali ndi matenda a cirrhosis, matenda a cirrhosis, kapena civerosis matenda a shuga. Pamafunika chipatala chapafupi IV m'badwo wachitatu cephalosporin (ceftazidime/ceftriaxone) kuphatikiza doxycycline.
3. Nyanja zamadzi amchere, mitsinje, maiwe, kapena mabulu (Aeromonas hydrophila): Kung'ambika m'mayiwe a madzi opanda mchere kapena mitsinje kumayambitsa cellulitis yofulumira kuchokera ku Aeromonas hydrophila, yomwe imafunika fluoroquinolone (ciprofloxacin) kapena trimethoprim-sulfamethoxazole kuwonjezeredwa kufupikitsa.
4. Machubu Otentha, Ma Salon a Misomali, kapena Kubowoleza Msomali Kudzera pa Rubber Sole (Pseudomonas aeruginosa): Kuponda msomali wa dzimbiri kudzera pa soli ya thovu ya nsapato ya tenisi kumalowetsa Pseudomonas aeruginosa m'mafupa a phazi, pomwe machubu otentha omwe alibe kloloni amachititsa Pseudomonas folliculitis.
5. Khungu Losweka Pakati Pa Zala Zapampando (Phazi la Wothamanga / Tinea Pedi): Mu 50 peresenti ya matenda a cellulitis a m'miyendo ya m'munsi, mabakiteriyawa adalowa m'ming'alu yaing'ono ya fangasi pakati pa chala chachinayi ndi chachisanu. Kuchiza matenda a fungal toe-web cream ndi topical antifungal cream pambuyo pochiritsa cellulitis kumalepheretsa kubwereza kwa mwendo wa cellulitis.

Mndandanda wa kupitirira kwa Sepsis: pamene matenda a khungu amakhala vuto la thupi lonse¶

Malinga ndi ** Surviving Sepsis Campaign ** ndi ** UK Sepsis Trust **, aliyense amene ali ndi cellulitis, erysipelas, lymphangitis, kapena chiphuphu chapakhungu ayenera kutengedwa ku dipatimenti yodzidzimutsa kuchipatala ngati apeza zizindikiro za **TIME / Red Flag Sepsis **:

• T - Kutentha kwachilendo: Kutentha kwamphamvu kopitilira 38.3 digiri Celsius (101 degrees Fahrenheit), kugunda kwamphamvu kwa mano (kuwuma), kapena kutentha kwapakati pathupi kutsika modabwitsa 36.0 digiri Celsius (96.8 degrees Fahrenheit).
• I - Zizindikiro za matenda zikuchulukirachulukira: Kufiira kumachulukira kuposa cholembera chanu mopitilira 1 mpaka 2 cm pa ola, mikwingwirima yofiyira ya ma lymphangitic yokwera m'mbali, kapena matuza atsopano ofiirira/akuda.
• M - Kutsika m'maganizo: Chisokonezo china chilichonse, kusalankhula bwino, kusokonekera, kugona mopanda khalidwe, kapena kudzuka movutikira.
• E - Kudwala kwambiri / Kupsyinjika kwamtima: Kupuma mofulumira (22 kapena kupuma mpweya wambiri pamphindi), kupumula kugunda kwa mtima kupitirira 100 mpaka 110 kugunda pa mphindi, chizungulire pamene mukuyimirira (kuthamanga kwa magazi kwa systolic pansi pa 100 mmHg), wotumbululuka / wamphumphu kapena kuzizira khungu la clammy + maola 12

Nambala zangozi zachigawo ndi ndondomeko za bungwe¶

• United States ndi Canada: Imbani 911 pa matenda aliwonse apakhungu omwe amatsagana ndi zizindikiro za sepsis, necrotizing fasciitis red flags, kapena kutupa kumaso/orbital. Pazithupsa zosavutikira kapena zoyamba za cellulitis popanda zizindikiro za dongosolo, pitani kuchipatala kapena dipatimenti yodzidzimutsa kuchipatala tsiku lomwelo (yoyendetsedwa pansi pa IDSA Skin and Soft Tissue Infection Guidelines).
• United Kingdom: Imbani 999 kapena pitani nthawi yomweyo ku A&E kuti mupeze zizindikiro zilizonse za NICE NG153 / UK Sepsis Trust Red Flag, orbital/face cellulitis, kapena lymphangitis yofalikira mwachangu. Imbani foni NHS 111 kuti mupeze GP wachangu watsiku lomwelo kapena kuwunika kwaposachedwa kwapang'onopang'ono kwa cellulitis kapena zithupsa.
• European Union: Imbani 112 m'maiko onse omwe ali m'bungwe la EU kuti mupeze ngozi zadzidzidzi kapena zosokoneza.
• Australia ndi New Zealand: Imbani 000 ku Australia kapena 111 ku New Zealand. Imayendetsedwa pansi pa Malangizo Ochizira: Maantibayotiki (Australia) ndi ANZCOR ma protocol a sepsis.
• India ndi Asia-Pacific: Imbani 112 (kapena 108 ku India), 995 ku Singapore, 119 ku Japan ndi South Korea, kapena 999 ku Malaysia ndi Hong Kong. Pitilizani ku chipatala chomwe chili ndi mphamvu za opareshoni ya maola 24 komanso kudzera m'mitsempha.

Mafunso omwe amafunsidwa pafupipafupi¶

Chifukwa chiyani ndiyenera kujambula cholembera kuzungulira matenda ofiira a pakhungu?¶

Kujambula mzere wokhala ndi cholembera kapena cholembera kumalire akunja a kufiyira ndikulemba nthawi yeniyeni pakhungu kumakupatsani inu ndi madotolo adzidzidzi chowongolera chowona kuti athe kuyeza ngati matendawa akuchulukirachulukira komanso mwachangu bwanji. Ngati redness yafalikira kupitilira inki yanu pakatha maola 1 mpaka 2 maantibayotiki asanayambe kuyambika, kapena kupitilira kupitilira maola 48 mutayamba kumwa maantibayotiki, zikuwonetsa kuti chipatala chikufunika kuwunika mwachangu kapena kudzera m'mitsempha.

Kodi mzere wofiyira kapena mizere yosuntha mmwamba mkono kapena mwendo wanga nditadulidwa kapena kulumidwa ndi kachilomboka kumatanthauza chiyani?¶

Mzere wofiyira womwe umayambira podulidwa, kukanda, kulumidwa ndi tizilombo, kapena kuphulika pamkono kapena kumunsi kwa mwendo kupita kukhwapa kapena groin ndi acute ascending lymphangitis, osati magazi omwe ali mkati mwa mtsempha. Zimatanthawuza kuti mabakiteriya owopsa (makamaka Gulu A Streptococcus) alowa m'mitsempha yamagazi ndipo akuyenda molunjika m'dera lanu komanso m'magazi apakati. Chifukwa lymphangitis imatha kupita ku bacteremia ndi sepsis mkati mwa maola angapo, muyenera kupeza chithandizo chadzidzidzi tsiku lomwelo kuti mupeze maantibayotiki.

Chifukwa chiyani ndizowopsa kufinya kapena kutulutsa chithupsa kapena chiphuphu cha MRSA kunyumba?¶

Mosiyana ndi ziphuphu zapakhungu, chiphuphu kapena chithupsa pakhungu ndi thumba lakuya la mafinya lozunguliridwa ndi khoma lolimba lomwe limateteza mabakiteriya kuti asatuluke m'magazi anu. Kufinya chithupsa kumapangitsa kuti madzi azithamanga kwambiri pamafinya, nthawi zambiri amaphulika khoma lakumbuyo mkati ndikukakamiza Staphylococcus aureus (MRSA) kukhala m'mitsempha yakuya, mitsempha, ndi ma lymphatic, komwe kungayambitse sepsis yamagazi, matenda a valve ya mtima, kapena matenda a msana. Pankhope (mphuno kapena kumtunda kwa milomo), kufinya chithupsa kumatha kukankhira zitseko zamadzi m'mbuyo mumphako wa ubongo.

Kodi ndingadziwe bwanji kusiyana pakati pa cellulitis wamba ndi necrotizing fasciitis yodya nyama?¶

Mu cellulitis wamba, khungu limakhala lapinki mpaka lofiira, lofunda, komanso lofatsa kwambiri pokhudza, ndipo kuchuluka kwa ululu kumafanana ndi momwe khungu limawonekera. Mu necrotizing fasciitis, matendawa amathamanga pamtunda wakuya pansi pa khungu, kuchititsa ululu waukulu wa 10/10 womwe umakhala wosiyana kwambiri ndi kufiira pang'ono pamwamba, kutsatiridwa mofulumira ndi kutupa kwamatabwa, zofiirira kapena zodzaza magazi, zigamba za khungu la dzanzi kumene mitsempha yafa, kuphulika kwa mpweya pansi pa khungu, chizungulire, chizungulire, ndi kutentha thupi. Necrotizing fasciitis ndizochitika zadzidzidzi za opaleshoni zomwe zimafuna kuchotsedwa mwachangu m'chipinda chopangira opaleshoni.

Chifukwa chiyani madokotala amati muyenera kukweza mwendo ndi cellulitis?¶

Bacterial cellulitis imayambitsa kutupa komweko komwe kumapangitsa kuti ma capillaries ang'onoang'ono atayike, kusefukira pakhungu ndi timinofu tating'onoting'ono ndi madzi ochulukirapo (edema). Ngati mwendo ulendewera pansi, mphamvu yokoka madzi madzi mu mwana wa ng'ombe ndi bondo, kutambasula khungu zolimba, compressing mitsempha yaing'ono ya magazi, kupweteka kwambiri, ndi kuchepetsa yobereka mankhwala ndi maselo oyera. Kukweza mwendo pamitsamiro pamwamba pa mlingo wa mtima kumakhetsa madzi ochulukirapo ndikufulumizitsa kuchira pakapita masiku.

Kodi wina angatenge cellulitis m'miyendo yonse nthawi imodzi?¶

Matenda a bakiteriya owopsa kwambiri omwe amakhudza miyendo yakumunsi nthawi imodzi ndi osowa kwambiri pokhapokha ngati munthuyo adapsa kapena kuvulala miyendo yonse nthawi imodzi. Mu 90 peresenti ya milandu yomwe munthu wamkulu amakhala ndi zofiira, zotupa, ndi kutupa kwa miyendo yonse yotsika kuchokera ku akakolo mpaka pakati pa ana a ng'ombe popanda kutentha thupi, vuto lenileni ndi venous stasis dermatitis (kuthamanga kwa mitsempha ya mitsempha), yomwe imafuna kukwera kwa miyendo ndi kuponderezana masitonkeni m'malo mobwerezabwereza mankhwala opha tizilombo.

Magwero ndi malangizo ovomerezeka¶

• Infectious Diseases Society of America (IDSA, United States): Malangizo Othandizira Kuzindikira ndi Kuwongolera Matenda a Khungu ndi Ofewa (Stevens et al., Clinical Infectious Diseases, purulent vs. non-purulent SSTI pathways, MRSA abscess incision and drainage, ndi necrotizing).
• National Institute for Health and Care Excellence (NICE, United Kingdom): Cellulitis and Erysipelas: Antimicrobial Prescribing (NICE Guideline NG141) ndi Sepsis: Recognition, Diagnosis and Early Management (NG51).
• World Society of Emergency Surgery (WSES) ndi Surgical Infection Society Europe (SIS-E): WSES/GAIS/SIS-E/WSIS/AAST Global Clinical Pathways for Odwala Odwala Khungu ndi Soft Tissue Infections.
• Centers for Disease Control and Prevention (CDC, United States): Clinical Guidance for Community-Associated Methicillin-Resistant Staphylococcus aureus (CA-MRSA) Matenda a Pakhungu ndi Vibrio vulnificus Wound Infections.
• Kupulumuka kwa Sepsis Campaign (SCCM / ESICM, International): Malangizo Apadziko Lonse Othandizira Sepsis ndi Septic Shock.

Maupangiri ogwirizana¶

• Necrotizing fasciitis (matenda odya nyama) ndi mbendera zofiira za cellulitis
• Sepsis ndi kuzindikira kugwedezeka kwa septic ndikuyesa mwadzidzidzi
• Orbital cellulitis, cavernous sinus thrombosis, ndi matenda owopsa pamakona atatu
• Pulmonary embolism ndi deep vein thrombosis (DVT)
• Kulumidwa ndi nyama, kukwapula kwa mphaka, ndi matenda a chiwewe