Emergency Flashcards
What are the risk factors for Necrotising Fasciitis?
Skin injury (insect bite, trauma, surgical wound) IVDU DM Malignancy TB Child: Post-VZV
How does Necrotising Fasciitis initially present?
- Unexplained constant severe limb pain
- DISPROPORTIONATE to physical signs
- Rapidly spreading erythema & sepsis
- N&V&D
- Poorly defined margins
- Tenderness extends beyond infection site
What are the later signs of Necrotising Fasciitis?
Day 2-4: Tense oedema Bullae (skin ischaemia) Rapid necrosis Paraesthesia (nerve destruction) Day 4-5: SEPTIC SHOCK
How is Necrotising Fasciitis investigated?
1) ↑WCC ↑CRP
2) X-ray – gas in affected area
3) Swabs MCS
How is Necrotising Fasciitis managed?
IV Abx: BenPen/Gent/Clindamycin
What is erythema Multiforme?
Hypersensitivity reaction to infection or drugs
What infections can lead to erythema multiforme?
HSV 1 & 2
Mycoplasma
Pneumonia
What drugs can lead to erythema multiforme?
Penicilin
Sulphonamides
Anti-convulsants
NSAIDs
How does erythema multiforme present?
Prodrome of URTI
THEN
Rash within 3d on extremities
Symmetrical & spreading centrally- hands & feet → torso
What are the ‘minor’ features of erythema multiforme?
Target lesions (dull red macule enlarges to bulla Flattens Intermediate ring forms + becomes raised, pale, oedematous
What are the ‘major’ features of erythema multiforme?
Target lesions + involvement of mucous membranes
What does recurrence of erythema multiforme suggest?
HSV reactivation
How is erythema multiforme treated?
1) Remove drug
2) PO Aciclovir (if HSV)
What is erythema nodosum?
Inflammation of subcut fat
What are the causes of erythema nodosum?
Systemic: Sarcoid, IBD, Bercet’s
Infection: Strep, TB, Brucellosis
Malignancy: Lymphoma
How does erythema nodosum present?
Typically shins but also forearms or thighs
INITIALLY: Fever, aching, arthralgia w/PAINFUL rash
Tender, erythematous, nodular lesions → tense & hard later
Develop blue-purple colour
How long does erythema nodosum take to resolve?
6weeks
What is Stevens-Johnson syndrome?
Severe + overlapping condition w/erythema multiforme
TYPICALLY DRUG INDUCED
Infective causes: Mycoplasma, Strep, HSV1
How does Stevens-Johnson syndrome present?
TARGET LESION RASH Erythematous, purple macpap rash OR haemorrhagic skin Develops into widespread blisters + bullae HAEMORRHAGIC crusting of mucous membranes RF Conjunctivitis Fever
What sign is indicative of SJS?
Nikolsky sign:
Rubbing causes separation at epidermo-dermal junction
How is Stevens-Johnson syndrome treated?
1) Supportive: Tx for burns (hydration, airway protection)
2) Identify cause
3) Emollients
4) Systemic steroids/IgG: FIRST 2-3DAYS
How does pyoderma gangrenosum present?
TYPICALLY lower limbs
Initial: Small red papule
Later: Deep, red, necrotic ulcers w/violaceous border
Fever & myalgia
What is pyoderma gangrenosum commonly associated with?
IBD RA SLE Lymphoma HSP Leukaemia
