Safe environment for disposition to home (does not include anticipated respite referral)
Adequate follow up and social support anticipated at time of discharge
Clinical picture consistent with cellulitis (s/p abscess I&D, if applicable)
Requiring IV Antibiotics
Requiring time to ensure non progressive course
Margins of Cellulitis outlined with skin marker
If Facial Cellulitis – CT max/face with contrast done and specialty face consult if needed
ED MD to consult Hand/Ortho as needed
Unstable vital signs, shock, or signs sepsis/severe sepsis
Suspicion for necrotizing fasciitis, Fournier’s gangrene or Ludwig’s angina
Complicated abscess, not amenable to ED drainage
Immunosuppressed (Chemotherapy, Solid Organ Transplant, AIDS etc)
Diabetic foot infections
Outline margins of erythema at admission, inspect q 4hrs with vital signs for progression/improvement
Elevate limb
IV Cephalosporin or Beta Lactam. E.g. Cefazolin 2000 mg Q8hr (renally dosed as indicated). Clindamycin is acceptable alternative if true cephalosporin AND beta lactam allergic.
MRSA coverage if purulent, history of MRSA or injection drug use. Appropriate agents include Linezolid, Clindamycin, TMP/SMX, Doxycycline, Oritavancin if unlikely or unable to obtain followup.
If pseudomonal coverage needed (unlikely CDU candidate) then add Ciprofloxacin.
Please reference the Antibiogram for more specific organism treatment recommendations
Sepsis screen with each set of vitals
Analgesics prn
Compression stockings at time of discharge for lower extremity cellulitis
Disposition
Stable, normal VS, afebrile
Stable or improving clinical signs/symptoms
Tolerating po
Follow up arranged
Abnormal, concerning VS
Progression of signs/symptoms
Unable to tolerate oral medications
Unable to care for wound at home, home care unavailable, including need for medical respite referral
New or alternative diagnosis requiring hospitalization identified
At the discretion of the ED physician, primary or consultant MD or CDU APP