Acute purulent infection of a single hair follicle and its associated sebaceous gland

The causative bacteria are Staphylococcus aureus or Epidermococcus

It often occurs in places rich in sebaceous glands such as the head, face, neck, back, armpits and groin.

More common in diabetic patients or children with low immunity

It is related to unclean skin, local abrasions, poor secretion of subcutaneous hair follicles and sebaceous glands, or reduced body resistance.

When the boils in the dangerous triangle area of ​​the face are squeezed, bacteria can enter the skull along the ophthalmic veins and medial canthal veins, causing suppurative cavernous sinusitis.

If the ulcer has not broken out early in the morning, you can apply iodine tincture, fish stone ointment or golden powder. If the abscess has formed, it must be incised and drained in time. Immature boils should not be squeezed.

Acute purulent infection of multiple adjacent hair follicles and surrounding tissues, which can also be caused by the fusion of multiple boils

The causative bacterium is Staphylococcus aureus

It often occurs in thick and tough areas such as the neck and back, and can also be found in the soft tissues of the upper lip and abdomen.

Common in adults, especially patients with diabetes and low immunity

Multiple "pus heads" are formed, and the carbuncle has a large infiltration range and can involve deep subcutaneous connective tissue.

The sores are honeycomb-shaped, like a "crater", and the local skin turns purple-brown due to tissue necrosis.

It is often accompanied by systemic symptoms such as chills, high fever, lack of appetite, and fatigue. Lip abscesses can easily cause intracranial suppurative cavernous sinusitis

treat

Refers to purulent infection under the skin, subfascia, intermuscular space or deep loose connective tissue

Beta-hemolytic Streptococcus (beta-hemolytic Streptococcus) is the most common, followed by Staphylococcus aureus and a few E. coli

Hemolytic streptococci can release highly toxic hemolysin, hyaluronic acid, and streptokinase. The inflammation is not easily localized and has unclear boundaries with the surroundings, which can cause obvious toxemia.

General subcutaneous cellulitis: redness, swelling, heat and pain, blisters of different sizes, local skin redness, slight fading when pressed, unclear boundaries, and often ischemic necrosis in the center of the lesion

Gasogenic subcutaneous cellulitis: caused by anaerobic bacteria, mostly occurring in the perineum or lower abdomen. The lesions are mainly in the subcutaneous connective tissue and do not invade the muscle layer. The pus has a foul smell and has crepitus.

neonatal subcutaneous gangrene

Acute cellulitis at the floor of the mouth, under the nose and neck: laryngeal edema is likely to compress the trachea, so incision and decompression should be made as soon as possible to prevent suffocation

50% magnesium sulfate solution for wet compress, or external application of golden powder or fish stone ointment

Penicillin and sulfa drugs are preferred for Staphylococcus aureus and Streptococcus infections

Abscesses should be incised and drained

Gasogenic subcutaneous cellulitis is flushed with 3% hydrogen peroxide solution and added with metronidazole

Acute lymphangitis: Bacteria invade lymphatic vessels and cause inflammation of surrounding tissues, rarely superficial necrosis or suppuration.

Superficial acute lymphadenitis: It usually occurs in the neck, armpits and groin, and can become purulent and form an abscess.

acute lymphangitis

Acute lymphangitis: regional lymphadenopathy

Tenosynovitis: Stretching your fingers can worsen the pain

Bursitis

palmar space infection

The causative bacteria are Clostridium tetani, Gram-positive anaerobic Clostridium spores

Narrow and deep wounds, local ischemia, foreign body retention, tissue necrosis, tight packing, wounds mixed with other aerobic bacteria, etc.

Incubation period: 7~8 days. The shorter the incubation period, the worse the prognosis. "Seven-day wind"

Prodromal stage: weakness in chewing and inconvenience in opening the mouth, with inconvenience in opening the mouth being the main feature

Attack stage: paroxysmal strong spasms, the first affected muscles are mastication

Any slight stimulation can induce strong paroxysmal spasms of muscles throughout the body, and the patient will be conscious during the attacks.

Complications: Muscle rupture, fractures, urinary retention, Main causes of death: Asphyxia, heart failure, lung infection

Eliminate the source of toxins: Thoroughly debridement after injection of tetanus antitoxin, open the wound, adequately drain it, and rinse with 3% hydrogen peroxide solution

Neutralize free toxins: Tetanus immune globulin (TIG) 3000~6000IU intramuscular injection; Tetanus antitoxin (TAT) 20,000~50,000 U intramuscular injection

Controlling and relieving muscle spasms: This is an important part of treatment. Commonly used drugs are 10% chloral hydrate, phenobarbital sodium, and diazepam.

Prevent and treat complications

Proper wound management: Thorough debridement, irrigation and wet dressing with 3% hydrogen peroxide solution

artificial immunity

Keep the respiratory tract open: tracheotomy as soon as possible. For those with channel convulsions, oral intake is prohibited.

prevent patient injury

Strengthen nutrition: high energy, high protein, high vitamins, eat small amounts frequently

Condition observation

general care

The causative bacterium is Gram-positive anaerobic Clostridium

Depends on the body's resistance and the hypoxic environment of the wound

Low resistance, open fractures, crush injuries with deep muscle injuries, prolonged use of tourniquets, too tight plaster bandages, etc.

Characteristics: The condition develops rapidly, and the overall condition can deteriorate rapidly within 12 to 24 hours. The incubation period is generally 1 to 4 days, with a minimum of 8 to 10 hours.

Early stage: "cracking" severe pain appears, which is the earliest symptom and cannot be relieved by general analgesics.

Late stage: there is crepitus around, bubbles often overflow from the wound, and thin and foul-smelling secretions flow out, muscle necrosis, no contraction or bleeding during incision

Laboratory tests: Large Gram-positive Clostridium can be detected

Imaging examination: X-ray and CT examination often show gas in the wound muscles.

Thorough debridement: Complete debridement while resisting shock. Extensive and multiple incisions are made in the diseased area to reach normal tissue. The incisions are open without suturing.

Antibiotic application: high-dose penicillin intravenous drip

hyperbaric oxygen therapy

pain care

Disinfection and isolation: contact isolation

Before the bacterial culture results are obtained, antibiotics should be used in combination as early as possible and in sufficient amounts, and adjustments will be made based on the results later.