Dermatology/Burns Review Flashcards
When is antibiotics recommended for dog bites?
Moderate to severe bite wounds and punctures
Facial bites, hand/foot, or genital area wounds
Immunocompromised or asplenic host
What is typical of the workup for a dog and human bite?1
X-ray for suspected fracture, penetrating wound over bone/joint, foreign body
Wound culture
What antibiotics is recommended for dog bites?
Amoxicillin-clavulanate PO
Consider vancomycin for MRSA coverage if severe
What are signs of systemic toxicity for a snake bite?
Tachycardia, hypotension
Swelling of airways
Altered mental status
What are the common labs after a snake bite?
Hemoglobin and Hematocrit Platelet Creatinine ALT/AST Coagulation studies CK
How do you dose anti-venom for snake bites?
Based on severity!
NOT based on weight/age
A snake bite that causes inflammation, redness, and joint pain along with tissue necrosis?
Brown recluse
A snake bite that causes intense pain with tachycardia, flushed appearance, and altered mental status
Black widow
Snake bite that causes ring of white tissue ischemia then blisters then has a bull’s eye effect
Brown recluse
Snake bite with acute pain, swelling, muscle spasms, tachycardia, hypertension, and agitation
Black widow
What is the “tap test” for a snake bite?
You tap the bite area and it causes severe pain
What is the best way to treat a jellyfish sting?
Double glove and remove adherent tentacles
Baking soda slurry (baking soda and water)
Topical steroids
Epidermal erythema and superficial necrosis with consistent pattern of progression with prodrome of URI and purulent conjunctivitis
Staph Scalded Skin Syndrome
Presents with erythema (redness around mouth and spreads with Nikolsky’s sign) and in the next 24-48 hours, there is exfoliation; then the next couple of days there is desquamation and then 5-7 days later there is new skin
Staph Scalded Skin Syndrome
What is the treatment for staph scalded skin syndrome?
Vancomycin IV/Clindamycin IV
Fluid and electrolyte management
What are the most common venomous snake species?
Rattlesnakes, cottonmouth moccasins, copperheads, and coral snakes
What are the diagnostic tests for brown recluse?
No specific lab tests
What are the diagnostic tests for black widow?
CBC, metabolic panel, coagulation studies, ECG, and urinalysis
What is the treatment for brown recluse bites?
Local debridement, elevation, loose immobilization, and cool compresses
Avoid strenuous activity
What is the treatment for black widow bites?
Local wound care, tetanous prophylaxis, pain control, cool compresses/ice packs
Treat infection with broad-spectrum antibiotics
Monitor for 6 hours in mild cases
How do you treat muscle cramps associated with black widow bites?
Benzodiazepines, opioids, or dantrolene
How do you treat bee and wasp stings?
Remove the stringer
Treat local reactions symptomatically
How do you treat anaphylaxis reaction to bee and wasp stings?
Epinephrine, corticosteroids, inhaled beta-adrenergic agonists, and H1 and H2 antihistamines
What is a rapidly progressing deep tissue involving fascial and muscle layers, skin, and subcutaneous tissue
Necrotizing fasciitis
Erythema, warmth, induration, and edema of skin at local inflammatory site; rapidly progressing; fever >39C
Associated with limited mobility of nearest joint
May progress to gangrene and tissue sloughing
Necrotizing fasciitis
What are the signs of compartment syndrome?
Edema, pain, loss of sensation, decreased/absent pulses on associated extremity
What are the common antibiotic types for necrotizing fasciitis?
Aerobic (penicillin G, ampicillin-sulbactam, clindamycin)
Anaerobic coverage (metronidazole, 3rd generation cephalosporin)
What is a hypersensitivity reaction affecting skin and mucous membranes that is commonly attributed to medication, infection, and environmental causes?
Stevens-Johnson Syndrome
What medications are associated with Stevens-Johnson Syndrome?
Antibiotics (sulfonamides), anticonvulsant medications (phenobarbital, lamotrigine, carbamazepine), nonsteroidal anti-inflammatory medications
A patient has high fevers, cough, rhinorrhea, pharyngitis, vomiting, diarrhea, headache, myalgia, and arthralgia. What disease are these symptoms related to?
Stevens-Johnson Syndrome
What is hypersensitivity reaction resulting in damage to epidermis?
Toxic epidermal necrolysis
A child presents with fevers, malaise, localized skin tenderness and diffuse erythema, painful, burning, erythematous, or dusky macule rash after 24 hours
Toxic epidermal necrolysis
Widespread blister formation or confluent erythema with skin tenderness
Absence of target lesions
Sudden onset within 24-48 hours
Full thickness epidermal necrosis
Toxic epidermal necrolysis
Localized injury to skin and/or underlying tissue usually over a bony prominence
Pressure ulcer
What is a non-blanchable erythema of intact skin that doesn’t resolve within 30 minutes of pressure relief?
Stage I pressure ulcer
What involves epidermis, dermis, or both presenting as shallow open ulcer with red pink wound bed without slough?
Partial thickness (Stage II) pressure ulcer
What is it when there is a full-thickness tissue loss with subcutaneous fat may be visible but bone, tendon or muscle is not exposed?
Full-thickness skin loss (Stage III) pressure ulcer
What is it when there is full-thickness tissue loss with exposed bone, tendon or muscle?
Full-thickness tissue loss (Stage IV) pressure ulcer
A 3-year-old girl presents to the ED for a progressive erythematous rash to her torso and bilateral lower extremities. She has had a fever for 1 day and has been receiving ibuprofen for the past 24 hours. What is the likely diagnosis?
A. Stevens-Johnsons syndrome
B. TEN
C. Necrotizing fasciitis
D. Kawasaki disease
TEN
Which of the following is a contraindication for NPWT in the pediatric patient?
A. Placing NPWT dressing over nerves
B. Using NPWT in a clean wound bed
C. Using a NPWT pressure setting appropriate for the child’s age
D. Using NPWT on a pediatric patient after flap surgery
A. Placing NPWT dressing over nerves
Which of the following is an advantage of using NPWT?
A. Decreases perfusion
B. Increases edema
C. Inhibits granulation tissue formation
D. Prepares wound bed for closure
D. Prepares wound bed for closure
When examining a patient with a confluent, erythematous sloughing rash. TEN is suspected. Which of the following physical examination supports diagnosis of TEN?
A. Target lesions
B. Crusted lesions
C. Petechiae
D. Skin tenderness
D. Skin tenderness
When evaluating a child with a prolonged hospitalization, it is noted that he has a blister on his sacrum. This lesion is categorized as which of the following pressure ulcer stages?
A. Stage I
B. Stage II
C. Stage III
D. Stage IV
B. Stage II
Which combination is the best choice for empiric antibiotic treatment of suspected necrotizing fasciitis?
A. Ampicillin and Flagyl
B. Vancomycin and ciprofloxacin
C. Bactrim and fluconazole
D. Rocephin and gentamycin
B. Vancomycin and ciprofloxacin
