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What recommendations would you make for this scalp cellulitis? The patient is also on IV ABX. Thanks.
Mar 19, 2018 by Amy Smith, JD, RN, PHN
3 replies
Julie Lientz
MSN, MBA, RN, WCC, CWON
It depends on the drainage of the wound, if not draining a lot I would use medihoney gel and cover with a foam dressing changing every other day. If has some drainage u can us a silver foam or awuacel ag and cover with foam. Again depending on drainage could change every 3-5days. IV antibiotics will help.
Mar 19, 2018
Elaine Horibe Song
MD, PhD, MBA
Hi Amy, thank you for your question, seems like an interesting case. In addition to Julie's well-stated answer, I'd suggest evaluation for soft tissue abscess. If an abscess is present, it must be drained (incision and drainage procedures are usually performed by an ED provider or Surgery). Due to the location (superficial temporal artery), an extensive incision would likely not be indicated, but it should be wide enough to allow complete drainage of pus, exploration of cavity for foreign body and irrigation with saline. A pus swab should be collected for culture. Agree with Julie's dressing recommendations and suggestion to use IV antibiotics, justified by facial cellulitis. As for choice of initial antibiotics, one could start with Nafcillin, oxacillin or cephazolin (community acquired infection) or vancomycin (hospitalized patient) and adjust treatment after culture results. Thank you, and please let us know if more information is needed.
Mar 19, 2018
Samantha Kuplicki
MSN, APRN-CNS, AGCNS-BC, CWS, CWCN-AP, RNFA
Elaine and Julie have presented some great information. I would add that I'm a little concerned about the lesion near the temple and the appearance of both areas, concerning for possible malignancy. Is the differential solid for abscess/cellulitis? Is it truly suppurative? Elevated WBC, febrile, pain, odor, etc? Just playing devil's advocate here :)
Mar 22, 2018
* Info provided without clinical evaluation and is not intended as a replacement for in-person consultation with a medical professional.