Derm

Question 1

Common rashes that present to the ED

Answer 1

• Scabies/bed bugs
• Shingles
• Allergic dermatitis
• Urticaria/hives
• Eczema

Question 2

Cellulitis

• describe
• RF

Answer 2

• Infection of skin layers, MC staph (MRSA)

- RF: DM, venous insufficiency (esp LE), immunocompromised

Question 3

Cellulitis

• S/sx
• Tx

Answer 3

• Local infection: warm, erythematous, tender
• Maybe fluctuant center (abscess)
• Most cellulitis does not blanch
• Systemic: local + fever, leukocytosis, myalgia

Tx:

• abx (DS Bactrim) or Keflex
• Fail, try IV abx
• Mark erythema to objectively measure spread

Question 4

Erysipelas

Answer 4

• Cellulitis caused by beta-hemolytic streptococci
• Similar s/sx to cellulitis but quicker onset, more well defined than cellulitis
• Tx: Rocephin IV
• Mark erythema to objectively measure spread

Question 5

Abscess

Answer 5

• Purulent material between skin layers
• Simple case w/o cellulitis: no abx
• Tx: I&D, Risky if large or can cause cosmetic issues (face, peri-rectal), get sx consult

Question 6

Paronychia

Answer 6

• Lateral nail fold infection, occasionally cuticle or eponychium
• Due to minor trauma: nail-biting, manicures, hangnails
• Tx: I&D, more likely to use abx than abscess somewhere else

Question 7

Felon

Answer 7

• SQ pyogenic infection of pulp space of distal finger/thumb, finger pads
• Suspect MRSA
• Look at lips: ensure not missing herpetic whitlow
• Tx: I&D (a little more difficult than abscess infections) and abx

Question 8

Laceration

- initial exam

Answer 8

• Eval wound: size, age, bleeding, neurovascular status distal to wound
• If dt crush injury, XR before repair
• Tendon damage: can’t move dt pain or lack of fn (document tested full ROM!!)
• After numb, explore wound

Question 9

Anesthesia

Answer 9

• Local: small amt injected along borders of wound
• Digital block: fingers and toes
• Field block: surrounding skin to ease pain
• Lidocaine: 1 – 2% burns more, lasts 4 hours
• Marcaine: 0.5% good for blocks, can last 8-9 hours
• Epinephrine: causes other to last longer, vasoconstriction (do not use on fingers, ears, lips, nose, toes, penis)

Question 10

Laceration repair

• suture types
• sizes

Answer 10

• Nylon (Ethilon): MC
• Polyglactin (Vicryl) : SQ, dissolvable
• Polypropylene (prolene): less scaring, best for face
• Chromic gut: mouth, vagina, anus. More fragile

Size (bigger number is smaller gauge)
• 3-0: body, trunk, gaping wound needs strength
• 4-0: MC, hands that are used a lot
• 5-0: face, soft fingers, genitalia
• 6-0: face, cosmetically important

Question 11

Suture removal times

Answer 11

• Face: 6 days
• Joint: 14 days
• Others: 7-10 days

Question 12

Other considerations regarding laceration repair

Answer 12

• Hands/feet: abx
• Suspect tendon injury: split and ortho/hand sx f/u
• > 6 hrs: increased risk infection – steri-strip and abx
• Tdap for updating tetanus (most adults need pertussis booster)

Question 13

Other materials to repair lacerations

Answer 13

• Staples: quick, good for scalp (hard to numb)
• Steri-strips: old lacs, kids, needle phobic, bites
• Glue: small kids, not good for hands or feet bc washing can remove it

Question 14

Laceration repair

Answer 14

• Be prepared!
• Proper cleaning – irrigation best option
• Clean surrounding skin: betadine or chlorhexidine
• > 6 hrs since occurred: incr risk infection so do not suture, use steri-strips or glue or loose sutures

Question 15

Puncture wounds

Answer 15

• Clean and check NV status
• Limited ROM or suspected FB: XR
• No sutures, staples, glue

Question 16

Dog (animal?) bites

Answer 16

• Animal control
• Clean and irrigation
• Only loose sutures
• Abx: augmentin
• Rabies prophylaxis

Question 17

Human bites

Answer 17

• Abx

- Swelling, erythema, streaking, decreased ROM: IV abx and ortho consult

Question 18

SJS

• describe
• s/sx

Answer 18

• Infection, HSV, drugs (abx and anticonvulsants) common cause
• Rash: widespread vesiculobullous lesion, erosion of mucous membrane
• Papules – target lesion – vesiculobullous

S/sx:

• Malaise, fever, myalgias, arthralgias
• Diffuse pruritis or general burning sensation prodrome

Question 19

SJS

- Tx

Answer 19

• IV fluid
• Steroids (dc if no improvement)
• Magic mouth wash
• Burn unit or burn center

Question 20

ITP

- describe

Answer 20

• Rare blood disorder, unknown cause
• Young healthy people
• Petechial rash first sx, easy bruising and bleeding gums

Question 21

ITP

- labs

Answer 21

CBC
CMP
PT/INR
UA (differentiate from other uremic issues that do have protein in the urine)
* will have extremely low platelets (1-3K)

Question 22

ITP

- Tx

Answer 22

• Steroids IV prednisolone

- Platelets