Cellulitis that is not settling
Educational use only. Not clinically reviewed55-year-old man for calm recognition, surgical activation, bounded antimicrobial intent, reassessment, and handoff practice. About 8 simulated minutes.
What you will practise
- Reconcile the disproportionate pain, the erythema border, and the failed oral treatment.
- Recognize that a score below its cutoff excludes nothing.
- Activate surgical review and mark the border.
- Review the score sensitivity and timing evidence boundary.
- Record bounded antimicrobial intent alongside surgical review, then reassess.
- Hand off an unconfirmed diagnosis and active risk.
Review and sources
Not clinically reviewed. No clinician has signed this scenario.
- Fernando SM, Tran A, Cheng W, et al. Necrotizing Soft Tissue Infection: Diagnostic Accuracy of Physical Examination, Imaging, and LRINEC Score: A Systematic Review and Meta-Analysis. Ann Surg. 2019;269(1):58-65. PMID:29672405. LRINEC at least 6: sensitivity 68.2%, specificity 84.8%; crepitus 25.2%; hypotension 21.0%; CT 88.5%.
- Sartelli M, Coccolini F, Kluger Y, et al. WSES/GAIS/WSIS/SIS-E/AAST global clinical pathways for patients with skin and soft tissue infections. World J Emerg Surg. 2022;17:3. doi:10.1186/s13017-022-00406-2. States a low LRINEC score does not rule out the diagnosis.
- Nawijn F, Smeeing DPJ, Houwert RM, et al. Time is of the essence when treating necrotizing soft tissue infections: a systematic review and meta-analysis. World J Emerg Surg. 2020;15:4. PMID:31921330. Surgery within 6 hours versus later: odds ratio 0.43 (95% CI 0.26-0.70); patient delay before presentation showed no significant effect.
Open Sim Lab is an educational simulator, not for clinical use. It is not a clinical decision-support tool, not a dosing calculator, and is not validated for any decision affecting a real patient.