Derm Flashcards
Things that must be documented by ED in a derm complaint
distribution, pattern, arrangement, morphology, extent, evolutionary changes
rash to flexor surfaces DDx
atopic dermatitis, candidiasis, eczema
sun exposure pattern rash ddx
sunburn, photosensitive drug rxn, SLE, viral exanthem
rash to distal extremities ddx
viral exanthema, atopic dermatitis, contact dermatitis, eczema, Rocky mountain spotted fever, gonnococemia,
rash to front and back of chest ddx
pityriasis rosea, syphilis, drug eruption, psoriasis
clothing covered distribution rash ddx
contact dermatitis, psoriasis, folliculitis
aciniform rash ddx
acne is the main one
Viral exanthems that start distal
erythema multiform, secondary syphillis, meningococcemia, dengue fever
conditions that you want to consult derm BEFORE you start the pt on steroids
erythema multiform, toxic epidermal necrolyisis and vasculitis
contraindications for PO steroids
DM, HTN, active PUD, psych disease, immunodef.
Area where silver sulfadiazine cannot be applied
the face! it will stain the face.
the least potent topical steroid
hydrocortisone. safe for face, finger, toes and no goes. and for kids.
the most potent topical steroid
Clobetasol or Halobetasol
medium potency topical steroids
Betamethasone, Triamcinalone, Fluticasone
steroid formulation that cannot be used in pregnacny
fluorinated formulations
conditions that require high potency steropid
psoriasis, severe eczema, severe poison ivy, severe atopic dermatitis
conditions that require moderate potency steroid
atopic dermatitis, stasis dermatitis, Tinea, seborrheic dermatitis, scabies
in genreal, 9 grams of topical steroid will cover
9% of body surface area for 1 day if applies 3x.day
amount of topical steroid that should be Rx in the ED
only enough for 2-3 days worth because they need follow up with derm/PCP
Wound and laceration things to worry about in the ED
- cosmesis
- Pain
- Infection
C/I for lidocaine with epi
fingers, toes, nose, and no-goes
most common suture used in ER
Nylon or proline, monofilament
suture in the face should be removed when?
3-4 d kids, 3-5 d adult
suture in the neck should be removed when?
2-3d kid 3-4 d adult
suture in the UE should be removed when?
7-10 d
suture in the hand should be removed when?
10-14 d
suture in the chest should be removed when?
7-10 d
suture in the back should be removed when?
10-14 d
suture in the legs should be removed when?
8-10d
suture in the foot should be removed when?
10-14d
suture over a joint should be removed when?
10-14d
wound with the highest risk of infection
puncture wound and animal bites (cats > dogs)
Tx for puncture/animal wound
IRRIGATION. allow for primary closure and do not give prophylactic abx if it is not a high risk plantar wound, but do give tetanus if indicated
Abx prophylaxis for animal/human bites
Augmenting
Utility of soaking wounds
NONE
Utility of specific solutions to irrigate
NONE. water works just fine.
Irrigation guidelines
35cc syringe with 19g needle. Be sure to use universal precautions and avoid splashing.
If had primary tetanus series and have had last dose within 5-10 years and you have a major wound
you need vac. booster
If had primary tetanus series and have had last dose within 5 years and you have a major wound
dont need anythign
If had primary tetanus series and have had last dose >10 years and you have a major wound
you need vac booster
if you have less than 3 tetanus series or are not sure and you have a minor wound
get tetanus vac. booster
if you have less than 3 tetanus series or are not sure and you have a major wound
give tetanus immunoglobulin and vaccine
S/Sx of black widow bite
redness and swelling (20-60min), pain and cramps (20-40min)
Tx options for black widow bites
Lyovac antivenin, benzos, opiates
S/Sx brown recluse bite
Bulls eye pattern, bluish discoloration, skin necrosis, pain (2-8 hrs)
tx options for brown recluse bite
Dapsone to halt tissue necrosis
Tx for urticaria
OTC cortrizine, ranitidine or cimetidine or steroids up to 1 week for severe
Tx for Contact dermatitis
remove offending agents, topical baths, OTC antihistamines, Hydracortazone of kenalog cream.
poison ivy steroid dose
can give 30-80mg/day of prednisone taper x 21 days for severe
PUP tx
high potency steroid, oral antihistamine. Can consider PO steroid
Tx for abscess
incision and drainage at bedside. Send home with bacterium X7-10 d if cellulitic or fever
Tx for mild cellulitis
PO outpatient Clindamycin or Cephalexin
Tx for cellulitis with systemic signs
admit to hospital for IV Ceftriaxone. If severe do IV vanco + Zosyn
