›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
12Imaging/img17
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
13Special Tests/spec7
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
14ECG/ecg8
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
15Assessment/ax16
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
16Plan/plan33
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
17Disposition/dispo18
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
18Discharge Instructions/di10
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
19References/r6
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
Evidence & Review
Reviewed by SymptomDx Medical Team·Last reviewed
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.