Bone infection

Osteomyelitis (bone infection) can occur with or without earlier injury

Red Flags — Urgent Medical Consult
Sign of sepsis High or low temperature Fast breathing Fast pulse Low BP or dizziness Confusion and/or agitation Child under 6 years with cellulitis Broken jaw with pus or bleeding around tooth Infection during wet season in tropical North Australia — may be melioidosis

Consider bone infection if

Cut or sore still has pus coming out after 14 days of standard treatment
Cellulitis over bone that is close to the surface (eg hands, fingers, toes, front of shin) is still there after 14 days of standard treatment
Skin infection for long/unknown time
Person with diabetes has slow-healing wound or ulcer, especially on feet

Consider melioidosis

Especially in tropical Northern Australia
In wet season or after floods
For people

With diabetes, chronic kidney disease, chronic lung disease
Who drink too much alcohol or kava
Who are debilitated (run down) or have history of melioidosis

Check

Calculate age-appropriate REWS

Adult — AVPU, RR, O₂ sats, pulse, BP, Temp
Child (less than 13 years) — AVPU, respiratory distress, RR, O₂ sats, pulse, central capillary refill time, Temp

Weight, BGL

Head-to-toe exam — with attention to

Painful, hot, tender at one point on bone — usually limb or backbone
Pain when tapping on bone away from sore area
Bone visible at the base of a sore or ulcer

Do

Medical consult to send to hospital urgently
Pain relief
Insert two IV cannula
Blood for cultures, pus swab
Best not to give antibiotics before cultures collected — blood culture, bone aspiration for MC&S done in hospital

If very sick or delay in sending to hospital — give cefazolin IV — adult 2g, child 50mg/kg/dose up to 2g — doses — single dose
If allergy — medical consult