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Plunkett Emergency > Dermatologic Emergencies > Flashcards

Dermatologic Emergencies Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What is a normal history of abscessing?

A

Outdoor cat with trauma or foreign body perforation

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2
Q

What physical exam findings can occur with abscesses?

A

Lethargy
Fever
Sometimes necrotic skin above abscess

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3
Q

What additional tests should be performed with abscesses in cats?

A

FeLV/FIV testing

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4
Q

What antibiotics are good for abscesses?

A 
Penicillins
Amoxicillin
Clavamox
Metronidazole
Chloramphenicol
Clindamycin
Third generation cephalosporins such as Simplicef or Convenia
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5
Q

What history is typically noted with burns?

A

Exposure to hot water, grease, tar, oil, electrocutions, etc.

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6
Q

What is a first degree burn?

A

Superficial burn involving epidermis
Painful, erythematous skin, +/- vesicles
Healing rapid when superficial desquamation occurs

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7
Q

What is a second degree burn?

A 
Partial thickness with epidermis and dermis
Pain 
Hair may be intact
Severe subcutaneous edema
Healing is slow after sloughing
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8
Q

What is a third degree burn?

A

Full thickness into dermis and subcutaneous tissue
Painless
Hair fall out
Skin appears black or white
Healing is slow unless graft is performed

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9
Q

What is a fourth degree burn?

A

Burns involving muscle and bone

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10
Q

What worsens the prognosis with burns?

A

If it affects the head or joints
In ole or young patients
If it affects > 20% of the body
Euthanasia should be a consideration if burns are severe

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11
Q

What are treatment options for first degree burns?

A

If they occurred in the past 2 hours, cool affected areas with cool water or saline
Pain control
Clean and clip area
Apply SSD and wound dressing once per day

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12
Q

What are treatment options for second degree burns?

A

Treat as first degree

Begin IV fluids for shock and for affected body surface area

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13
Q

What are treatment options for third degree burns?

A 
Discuss euthanasia
Remove lesions if small
Monitor for shock and septicemia
Apply hydrotherapy
Give a broad spectrum under eschar if present and start IV broad spectrum antibiotics
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14
Q

What can be used to remove hot tar?

A

Polyoxyethylene sorbate and polysorbate, the emulsifiers in Neosporin and other antibiotic creams

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15
Q

What are differentials for a cutaneous foreign body?

A

Hematoma, infection, seroma, neoplasia

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16
Q

What is important to remember about about grass awn foreign bodies?

A

They tend to migrate - will cause a draining tract until removed

17
Q

How should cactus spines or porcupine quills be removed?

A

Do not clip the area
Grasp spines with hemostats and pull out
Soak hemostats in water to remove afterward

18
Q

How should fishing hooks be removed?

A

Cannot be backed out due to bard
Press hook through tissues until hook and barb can be visualized
Grab hook, cut off shank, pull out hook

19
Q

How should treble hooks be removed?

A

Remove shank that attaches to hooks to separate them as separate hooks
Remove then as fishing hooks

20
Q

How should bee stingers be removed?

A

Scrape with a scalpel blade as grasping them may push venom into wound

21
Q

How should cutaneous foreign bodies be removed?

A

Clip an clean area
Probe with mosquitoes or hemostats
Flush tract with sterile saline

22
Q

What are causing of toxic epidermal necrolysis/ erythema multiforme?

A 
Antimicrobials (penicillins, cephalosporins, gentamicin, sulfonamides, griseofulvin)
L-thyoxine
Levamisole
Aurothioglucose
5-fluorocytosine
Diethylcarbamazine
Antiserum
Toxins (insecticides, flea dips, d-limonene)
Endocarditis
Hepatic necrosis
Cholangiohepatitis
23
Q

What do toxic epidermal necrolysis/ erythema multiforme appear like on physical exam?

A

Painful
Macular, papular, bullous, vesicular, target-like lesions
Multiple are noted and these typically coalesce and slough
Appear on the trunk (stomatitis and paw lesions noted)
Fever
Nokolsky’s sign (lesions can be moved around, creating new ulcers)

24
Q

What is the prognosis for toxic epidermal necrolysis?

A

Guarded to poor

This is difficult to manage

25
Q

How should toxic epidermal necrolysis/ erythema multiforme be treated?

A

Discontinue any suspicious medications
Start immunosuppressive dose of pred
Clean and debrde area
Apply SSD cream and bandage

26
Q

When does juvenile cellulitis/ puppy strangles occur?

A 
Puppies less than 16 weeks
Swelling around face and neck
Lethargy
Anorexia
Seen in Goldens and Dachshunds
Mucupurulent ocular and otic discharge
Submandibular enlargement +/- rupture with rupture
27
Q

What is the prognosis for puppy strangles?

A

Fair to guarded

Some puppies may die

28
Q

What is the treatment for puppy strangles?

A

1 mg/kg PO BID x 14 days, then taper
Antibiotics (amoxicillin, cephalexin, Simplicef,)
Lance SM lymph nodes if respiratory distress is noted

29
Q

What causes aural hematomas?

A

Auricular artery ruptures secondary to allergies, foreign bodies, ear infections, ear mites, etc.

30
Q

What is conservative therapy for acute aural hematomas (< 4 days)?

A

Needle aspiration followed by a pressure wrap

Recurrence is common

31
Q

How can you apply a teat cannula to an aural hematoma?

A

Surgical prep medial aspect of ear
Make a 0.5 cm incision at distal and gravity dependent portion of hematoma
Make two holes in teat cannula with a 19-20 G catheter
Insert cannula into ear and suction as much fluid out of ear as possible
Suture canula to ear with with 1-2 3-0 nylon at the base of the canula
Clean every day
Remove in 3 weeks

32
Q

What is surgical therapy for an aural hematoma?

A

Clean and prep medial ear
Make an S-shape superficial incision over hematoma
Remove fibrin clot
Flush with saline
Loosely apply 5-6 horizontal mattress sutures away from incised hematoma to allow drainage
Apply bandage to ear for 10 days
Remove sutures in 14-21 days

33
Q

What are examples of ceruminolytics for ear infections?

A

Carbamide peroxide

Dioctyl sodium sulfosuccinate (DSS)

34
Q

What are examples of antiseptics for ear infections?

A

Chlorhexidine

Acetic acid

35
Q

What are examples of antistringents for ear infections?

A

Salicyclic acid
Boric acid
Isopropyl alcohol

36
Q

What are differentials for a swollen anal gland?

A 
Neoplasia
Perianal gland neoplasia
Hematoma
Perineal hernia
Perianal fistula
Abscess
Spider bite

Plunkett Emergency (8 decks)

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