Derm Flashcards
1
Q
Common rashes that present to the ED
A
- Scabies/bed bugs
- Shingles
- Allergic dermatitis
- Urticaria/hives
- Eczema
2
Q
Cellulitis
- describe
- RF
A
- Infection of skin layers, MC staph (MRSA)
- RF: DM, venous insufficiency (esp LE), immunocompromised
3
Q
Cellulitis
- S/sx
- Tx
A
- 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
4
Q
Erysipelas
A
- 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
5
Q
Abscess
A
- 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
6
Q
Paronychia
A
- 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
7
Q
Felon
A
- 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
8
Q
Laceration
- initial exam
A
- 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
9
Q
Anesthesia
A
- 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)
10
Q
Laceration repair
- suture types
- sizes
A
- 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
11
Q
Suture removal times
A
- Face: 6 days
- Joint: 14 days
- Others: 7-10 days
12
Q
Other considerations regarding laceration repair
A
- 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)
13
Q
Other materials to repair lacerations
A
- 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
14
Q
Laceration repair
A
- 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
15
Q
Puncture wounds
A
- Clean and check NV status
- Limited ROM or suspected FB: XR
- No sutures, staples, glue
