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ER 1 > Derm > Flashcards

Derm Flashcards

1
Q

Common rashes that present to the ED

A
  • Scabies/bed bugs
  • Shingles
  • Allergic dermatitis
  • Urticaria/hives
  • Eczema
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2
Q

Cellulitis

  • describe
  • RF
A
  • Infection of skin layers, MC staph (MRSA)

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

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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
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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
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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
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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
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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
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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
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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)
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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
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11
Q

Suture removal times

A
  • Face: 6 days
  • Joint: 14 days
  • Others: 7-10 days
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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)
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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
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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
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15
Q

Puncture wounds

A
  • Clean and check NV status
  • Limited ROM or suspected FB: XR
  • No sutures, staples, glue
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16
Q

Dog (animal?) bites

A
  • Animal control
  • Clean and irrigation
  • Only loose sutures
  • Abx: augmentin
  • Rabies prophylaxis
17
Q

Human bites

A
  • Abx

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

18
Q

SJS

  • describe
  • s/sx
A
  • 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
19
Q

SJS

- Tx

A
  • IV fluid
  • Steroids (dc if no improvement)
  • Magic mouth wash
  • Burn unit or burn center
20
Q

ITP

- describe

A
  • Rare blood disorder, unknown cause
  • Young healthy people
  • Petechial rash first sx, easy bruising and bleeding gums
21
Q

ITP

- labs

A

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

22
Q

ITP

- Tx

A
  • Steroids IV prednisolone

- Platelets

ER 1 (18 decks)

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