Browse categories and answer follow-up questions to refine your symptom profile.
History
Visit context
Wound timeline and procedure details
Procedure type
Date and time of closure
Location and side
Mechanism of injury
Contamination risk
Irrigation performed
Foreign body concern at time of repair
Layered closure
Suture type and size
Number of sutures
Closure method
Staples
Tissue adhesive
Steri strips
Packing placed
Drain placed
Hemostasis method
Tetanus status at time of repair
Antibiotics given at time of repair
Current concerns
Symptom and wound change summary
Increasing pain
Increasing redness
Increasing swelling
Warmth
Drainage
Purulent drainage
Bloody drainage
Clear drainage
Foul odor
Wound separation
Suture loosening
Bleeding recurrence
Fever
Chills
Malaise
Numbness
Tingling
Reduced range of motion
Functional limitation
Pain or symptom OPQRST
OPQRST
Onset
Time since procedure when symptoms began
Sudden onset
Gradual onset
Provocation and palliation
Worse with movement
Worse with dependent positioning
Worse with pressure or touch
Better with elevation
Better with rest
Better with analgesics
Quality
Throbbing
Sharp
Burning
Pressure
Region and radiation
Localized to wound
Spreading along limb
Proximal streaking
Severity
Mild
Moderate
Severe
Timing
Constant
Intermittent
Progressive
Worse at night
Wound care and exposures since repair
Post repair course
Dressing changes performed
Wound kept clean and dry
Shower or water exposure
Soaking exposure
Topical products used
Picking or scratching
Re injury
Occupational exposures
Pet contact
Bite exposure
Swimming exposure
Associated symptoms
System symptoms
Fever or rigors
New confusion
Vomiting
Chest pain
Dyspnea
Limb swelling disproportionate
Progressive weakness
Alarm Features
Immediate escalation triggers
Time critical red flags
Hemodynamic instability
Altered mental status
Rapidly progressive erythema
Pain out of proportion
Skin necrosis
Bullae
Crepitus
Anesthesia over skin
Compartment syndrome concern
Uncontrolled hemorrhage
Expanding hematoma
Systemic toxicity
Immunocompromised with infection signs
High risk wound features
Wound specific red flags
Deep space infection concern
Tendon exposure
Joint involvement concern
Open fracture concern
Retained foreign body concern
Extensive contamination
Human bite
Cat bite to hand
Plantar puncture wound
Perineal wound infection concern
Facial wound with swelling near eye
Vital sign danger thresholds
Vital sign risk patterns
Persistent tachycardia
Fever
Hypothermia
Hypotension
Tachypnea
Hypoxia
Medications
Current meds and recent changes
Medication exposure
Recent antibiotics
Missed antibiotic doses
Analgesics
Acetaminophen
NSAIDs
Opioids
Topical anesthetics
Topical antibiotics
Corticosteroids
Immunosuppressants
High risk medication classes
Medication risk modifiers
Anticoagulants
Antiplatelets
SGLT2 inhibitors
Chemotherapy
Biologics
Chronic steroids
Allergy history
Antibiotic and topical allergies
Penicillin allergy phenotype
Cephalosporin reaction history
Sulfonamide reaction history
Chlorhexidine sensitivity
Adhesive allergy
Diet
Intake and hydration
Recent intake
Poor oral intake
Vomiting limiting intake
Dehydration symptoms
Normal intake
Glycemic and nutrition context
Healing risk nutrition context
Diabetes diet adherence
High protein intake
Malnutrition risk
Review of Systems
Constitutional and infection
System screen
Fever
Chills
Night sweats
Fatigue
Skin and soft tissue
Local symptom screen
New rash
Spreading redness
New swelling
Drainage
Itching
Neurovascular distal to wound
Distal symptom screen
Numbness
Tingling
Weakness
Coldness
Color change
Cardiopulmonary
Systemic complication screen
Chest pain
Dyspnea
Palpitations
Collateral History and Family History
Collateral and reliability
Collateral context
Source available
Wound care adherence reliability
Supervision reliability
Family history relevant to complications
Family risk
Bleeding disorder history
Keloid tendency
Early cardiovascular disease
Risk Factors
Host factors for infection and poor healing
Patient risk
Diabetes mellitus (E11.9)
Peripheral arterial disease (I73.9)
Chronic kidney disease (N18.9)
Chronic liver disease
Malnutrition
Obesity (E66.9)
Smoking
Alcohol use disorder (F10.20)
Immunocompromised state
Procedure and wound factors
Wound risk
Crush injury
Devitalized tissue
Delayed closure
Contaminated wound
Bite wound
Puncture wound
High tension closure site
Poor perfusion location
Bleeding and thrombosis risks
Coagulation and clot risk
Anticoagulant use
Antiplatelet use
Known bleeding disorder
Prior venous thromboembolism
Recent immobilization
Differential Diagnosis
Life threatening
Cannot miss diagnoses
Necrotizing soft tissue infection
Disproportionate pain
Rapid progression
Crepitus or bullae
Sepsis
Hypotension
Altered mental status
Compartment syndrome
Pain with passive stretch
Tense compartments
Arterial injury
Expanding hematoma
Distal ischemia signs
Deep venous thrombosis (I82.409)
Unilateral swelling
Calf tenderness
Common
Common causes
Uncomplicated healing course
Mild erythema at suture entry sites
Mild tenderness improving over time
Cellulitis (L03.90)
Spreading erythema
Warmth
Superficial wound infection
Local purulence
Increased pain
Abscess (L02.91)
Fluctuance
Point tenderness
Seroma
Clear fluid collection
Non toxic appearance
Hematoma
Ecchymosis
Anticoagulant association
Dehiscence
Wound separation
Tension at site
Less common and mimics
Less common causes
Allergic contact dermatitis
Itch predominant
Tape distribution
Suture reaction
Localized granuloma
Minimal systemic symptoms
Retained foreign body
Persistent focal pain
Non healing
Osteomyelitis (M86.9)
Deep tenderness
Persistent drainage
Septic arthritis (M00.9)
Adjacent joint pain
Limited range of motion
Past Medical History
Comorbidities affecting healing
Relevant conditions
Diabetes mellitus (E11.9)
Peripheral vascular disease (I73.9)
Chronic kidney disease (N18.9)
Immunodeficiency
Malignancy
Connective tissue disease
Prior wound history
Prior course
Prior wound infections
Prior MRSA colonization or infection
Prior keloids or hypertrophic scarring
Procedures and devices
Relevant procedures
Prior surgeries near site
Prosthetic joint near wound
Vascular graft near wound
Implanted hardware near wound
Physical Exam
General and vitals
Overall status
Appearance
Toxicity
Hydration
Fever pattern
Hemodynamic stability
Wound inspection
Local exam
Location and size
Surrounding erythema extent
Warmth
Induration
Fluctuance
Tenderness
Crepitus
Bullae
Necrosis
Drainage presence
Drainage character
Odor
Suture integrity
Staple integrity
Edge approximation
Dehiscence depth
Exposed structures
Foreign material
Neurovascular exam distal to wound
Distal function
Sensation
Motor strength
Capillary refill
Pulses
Skin temperature
Compartments
Regional and systemic exam
Extension assessment
Lymphangitic streaking
Regional lymphadenopathy
Joint exam near wound
Range of motion limitation
Pain with passive stretch
Lab Studies
Infection and inflammation labs
Lab selection
CBC for leukocytosis or left shift
CRP for trend support
ESR for deeper infection support
Lactate for systemic hypoperfusion concern
Metabolic and organ function
Systemic assessment labs
Electrolytes for dehydration or renal dysfunction
Creatinine for antibiotic dosing context
Glucose for hyperglycemia and healing risk
Liver enzymes if severe infection concern
Microbiology
Culture guidance
Purulent drainage culture
Blood cultures if systemic toxicity
Avoid superficial swab if no purulence
Bleeding risk labs
Coagulation labs
INR if warfarin use
Platelets if bleeding or anticoagulant context
Type and screen if significant hemorrhage
Imaging
Scoring Systems
Risk tools
LRINEC for necrotizing infection support
qSOFA for sepsis risk screen
SIRS criteria for systemic inflammation screen
MRI
MRI role
Suspected osteomyelitis
Suspected deep fascial involvement
Suspected septic arthritis extension
CT
CT role
Deep space infection
Gas in soft tissues
Complex abscess mapping
Retained foreign body
Ultrasound
Ultrasound role
Abscess versus cellulitis differentiation
Foreign body detection for radiolucent material
POCUS guidance for incision and drainage
Special Tests
Bedside diagnostics and maneuvers
Bedside assessment
Probe to depth for sinus tract concern
Passive stretch pain for compartment syndrome concern
Blanching assessment for perfusion concern
Procedure related evaluation
Closure integrity
Gentle wound edge stress assessment
Evaluation for buried suture reaction
ECG
Indications in wound related visits
ECG context
Sepsis with tachycardia
Electrolyte abnormalities concern
Older patient with systemic symptoms
High risk patterns affecting disposition
ECG red flags
New ischemic changes
Wide complex tachycardia
Atrial fibrillation with rapid ventricular response
Assessment
Working problem list
Problem representation
Post laceration repair wound check
Concern for infection versus normal healing
Concern for dehiscence
Concern for abscess
Severity and risk stratification
Risk level
Local infection without systemic features
Systemic features consistent with sepsis
High risk host factors
High risk wound location
Complications to exclude
Complication screen
Necrotizing soft tissue infection concern
Septic arthritis concern
Osteomyelitis concern
Compartment syndrome concern
Retained foreign body concern
Plan
First 5 minutes workflow
Immediate priorities
Monitor if systemic symptoms
IV access if toxicity or hypotension
Analgesia early if significant pain
Rapid exam for necrotizing infection signs
Wound management
Local management
Cleanse and irrigate if contaminated
Remove sutures partially if purulence under closure
Open and drain if abscess suspected
Packing if cavity present
Elevation for edema reduction
Non adherent dressing
Avoid occlusive dressing if draining
Antibiotics and tetanus
Anti infective and prophylaxis
Cephalexin PO 500 mg every 6 hours for 5 days for mild non purulent cellulitis local protocol dependent
Clindamycin PO 300 mg every 6 hours for 5 days for beta lactam allergy local protocol dependent
Doxycycline PO 100 mg twice daily for 5 days for MRSA risk with purulence local protocol dependent
Add amoxicillin clavulanate PO 875 mg twice daily for bite wounds local protocol dependent
Tetanus booster if not up to date local protocol dependent
Pain control
Analgesia
Acetaminophen PO 1000 mg every 6 to 8 hours maximum 3000 mg per day local protocol dependent
Ibuprofen PO 400 mg every 6 to 8 hours with food if no contraindication
Avoid NSAIDs if significant bleeding or renal risk
Reassessment loop
Recheck plan
Repeat vitals after analgesia and fluids if given
Reassess wound after irrigation and drainage
Reassess distal neurovascular status after any procedure
Reassess pain trajectory within 30 to 60 minutes in ED
Consultation
Specialty triggers
Hand surgery for hand infections or tendon involvement
Orthopedics for joint involvement or hardware
Vascular surgery for ischemia or expanding hematoma
General surgery for necrotizing infection concern
Disposition
Discharge criteria
Safe discharge
Hemodynamically stable
No systemic toxicity
No necrotizing infection concern
No deep structure exposure
Reliable wound care and follow up
Observation or admission criteria
Higher level care
Systemic infection signs
Rapid progression despite initial care
Extensive cellulitis
Need for IV antibiotics
Uncontrolled pain
High risk host factors with infection
Transfer criteria
Transfer triggers
Suspected necrotizing infection
Compartment syndrome concern
Complex hand infection
Threatened limb perfusion
Discharge Instructions
Copy discharge instructions
Patient instructions
Keep the wound clean and dry for the next 24 hours unless told otherwise
Change the dressing daily or sooner if wet or dirty
Do not soak the wound in a bath or pool until fully healed
Elevate the area when possible to reduce swelling
Take your antibiotics exactly as prescribed if given
Use acetaminophen or ibuprofen as directed for pain unless you were told not to
Return immediately for fever, spreading redness, worsening pain, pus, bad smell, wound opening, numbness, weakness, pale or cold skin, or uncontrolled bleeding
Follow up in 24 to 48 hours for recheck if infection concern or drainage was performed
Suture removal timing depends on location and will be arranged or discussed in follow up
References
Guidelines and key sources
Reference list
Infectious Diseases Society of America practice guidelines for skin and soft tissue infections 2014
ACEP clinical policy and resources for skin and soft tissue infections and abscess care local protocol dependent
CDC tetanus vaccination recommendations 2024
NICE guidance on surgical site infection prevention and management latest update local protocol dependent
UpToDate wound management and laceration repair aftercare topic review local protocol dependent
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.