May 26, 2017

Interview Transcript

Interviewer: Skin infections, when is it the time to go to the ER? We'll talk about that next on The Scope.

Announcer: This is From the Frontlines with emergency room physician Dr. Troy Madsen on The Scope.

Interviewer: So here's the situation. You've got this redness on your arm. It could be from maybe an ingrown, a cut, maybe an ingrown toe nail. Maybe it's just redness on your arm that starts spreading and taking up more and more of your skin. It could be an infection. Should you go to the ER for that? Dr. Troy Madsen is an emergency room physician at University of Utah Health. First of all, I think it's important to say that infections can be really serious. Like, we tend to forget how bad they can be because we've gotten really good at dealing with them.

Dr. Madsen: That's exactly right. Infections are one of these things where you may look down, again, at your arm or your leg, you see some area of redness, you think, "Oh, it's just going to get better." But we often sort of take for granted that, yes, infections are easy to treat, they don't kill people. But we certainly see cases in the ER of very serious infections. Oftentimes people who have put off going to the ER for whatever reason, where that infection grows, it's a very serious infection, it then leads to sepsis or an infection into the blood stream, and sometimes can be a life-threatening thing.

Interviewer: So that type of an infection, would it ever get better just on its own? Like, if I see that red area on my arm and it starts to spread, and I'm like, "Well, I really don't want to go to the ER. Maybe it'll just get better." Will it get better without treatment? Will my immune system fight it off?

Dr. Madsen: Usually not. The cases we see. . .

Interviewer: Really?

Dr. Madsen: Yes. It's one of these things where once you get that bacterial infection that settles in there, say, in the arm or in the leg or wherever it is and for whatever reason, oftentimes I don't have a great answer for why this infection started. It's typically not going to get better without antibiotics. The exception to that might be if you have a little abscess, so like a little pocket of infection and maybe it starts to drain, that sort of thing once it drains may get better. But if that infection then spreads to the skin around that abscess where you start to get a lot more redness, it's expanding, you see red streaks tracking up your arm, that can be a very serious thing and without at least starting some sort of antibiotic, whether it's oral antibiotics or, in more serious cases, IV antibiotics, it's really not going to get better.

Interviewer: ER or urgent care?

Dr. Madsen: If it's the sort of thing where it's just a local area of redness, maybe not bigger than, say, 3 or 4 inches long, you're probably okay to go to an urgent care. They'll prescribe some antibiotics. But if you're having fevers with it, chills, you see streaks tracking up your arm, I would recommend going to the ER because those are cases where you may need some blood work, you may even need IV antibiotics and admission to the hospital.

Interviewer: Got you. So, if you have an infection and it continues to get bigger and bigger, it's not going to get better on its own, you do need to go talk to somebody, otherwise it could be bad news.

Dr. Madsen: Exactly. Another thing to watch for with infection, there are cases you may have heard of flesh-eating bacteria. It's a scary sounding thing. But there are cases of really serious infections that you need to get to an ER as quickly as possible. And these are infections usually in people who may have some immune system problems, maybe they have diabetes, maybe they have cancer where they're on treatment for that.

But these are infections where it's a very, very rapidly spreading infection, and you feel sick, and you may even push on that area of infection and it feels kind of crunchy, kind of a weird sort of feeling to it like there's air under the skin. This is something that's called necrotizing fasciitis, and this is something where you need to get to an ER as quickly as possible, as that it's the sort of thing that often requires surgery. It's rare, but we see it, something that's worth mentioning with a rapidly spreading infection. So infections, something that may seem simple, but it's not something to mess around with.

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