Spine Dehiscence / Infections

FACTS

 

HPI

  • check for the following recent labs: HgA1c, prealbumin
  • evaluate hemodynamics (important to know if patient is septic from wound)
      • SIRS: 2 or more of the following
      1. Temperature >38°C (100.4°F) or <36°C (96.8°F)
      1. Heart rate >90 bpm
      1. Respiratory rate >20/min or PaCO₂ <32 mmHg
      1. WBC count >12,000/mm³, <4,000/mm³, or >10% bands
      Sepsis: SIRS + confirmed infection / organ dysfunction

      Organ dysfunction
    • Hypotension (SBP <90 mmHg or MAP <65)
    • Altered mental status
    • Elevated creatinine or bilirubin
    • Low platelets
    • Hypoxemia (PaO₂/FiO₂ <300)
      •  

    PHYSICAL EXAM

    universal exam
    • evaluate wound dehiscence based on depth (supra-fascial or deep?)
    • Is wound draining spontaneously?
    • Is wound tender
    • Does wound have foul smell?

    IMAGING

     
    A/P
    • Labs:
      • ESR/CRP, prealbumin, A1c (if none in past 3 months)
      • Blood cultures
      • Urinalysis
      • MRSA swab
      • Track response to infection with CRP, not WBC or ESR which are variable and may persistently remain high
    • Imaging:
      • start with a CT without contrast, ostensibly to evaluate hardware (if present) and to see if there is a large evident seroma
      • may consider MRI with or without contrast, but ask attending before
    • Swabbing wound:
      • at discretion of attending - these will often be contaminated especially if collected from skin
    • May consider surgical ID consult