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Urgent Care Guide > Skin 3 > Flashcards

Skin 3 Flashcards

1
Q

mammalian bite - general w/u
4

A
  1. evaluate need for rabies prophylaxis
  2. tetanus proph
  3. consider HIV and hep B post exposure proph (PEP) for very rare high risk human bites (blood to blood contact)
  4. clean wound
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2
Q

mammalian bite - rabies prophylaxis
2

A
  1. consider rabies immune globulin
  2. consider rabies vaccine dosing schedule
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3
Q

mammalian bite - how to cleanse wound

A

copiously irrigate wounds under pressure w/ NS

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4
Q

mammalian bite - closure of wound

A

primary closure not rec except for facial wounds

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5
Q

mammalian bite - facial wounds closure

A

loosely approximated w/ sutures or sterile tape

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6
Q

mammalian bite - mod/high risk bites include those from
3

A
  1. cat
  2. crush injuries
  3. puncture wounds
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7
Q

mammalian bite - mod/high risk bites tx

A

abx proph for 3-5 days

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8
Q

mammalian bite - mod/high risk bites, consider abx in patients with
4

A
  1. immunosuppression
  2. asplenic
  3. DM
  4. advanced liver dx
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9
Q

mammalian bite - mod/high risk areas, consider abx, include
4

A
  1. face
  2. hands
  3. genitals
  4. chronic edematous or compromised skin
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10
Q

mammalian bite - consider abx if there is concern for

A

compliance/fu

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11
Q

mammalian bite - infection present, tx w/ abx for how long

A

7-10 days

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12
Q

mammalian bite - infection present abx options
4

A
  1. Augmentin 875 mg (25 mg/kg) PO BID
  2. cefuroxime 500 mg (P 15 mg/kg) PO BID + metronidazole 500 mg (P 15 mg/kg) PO q8h
  3. moxifloxacin 400 mg PO once daily
  4. clindamycin 450 mg (P 10 mg/kg) PO q8h + bactrim or cipro or doxy
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13
Q

rabies prophy includes (from CDC)
3

A
  1. clean wound with sterile water and povidone iodine if available
  2. administer immune globin - The recommended dose of HRIG is 20 IU/kg body weight. This formula applies to all age groups, including children. Administer around the wound edges until wound appears infiltrated. Best to get all immunoglobin into wound but if left over, administer in distal site to rabies vaccine. i.e. 5 cc left over, split into 2.5 cc syringes and give IM
  3. give rabies vaccine IM - one each on days 0 , 3, 7, and 14. A fifth dose on day 28 is recommended for persons with a confirmed or suspected immune disorder
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14
Q

rabies proph - where to administer

A

adults - deltoid
children - deltoid or anteriolateral thigh
- never in butt d/t slow absorption

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15
Q

rabies - what does the immune globulin provide

A

antibodies right away until the body can make its own

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16
Q

water exposure wounds rx
2

A
  1. cephalexin 500 mg PO q6h x 10 days
  2. severe PCN allergy - clindamycin 450 mg PO (P 10 mg/kg) q8h + levo 750 mg PO daily
17
Q

water exposure wound with sewage/contaminated water add what abx

A

metronidazole 500 mg PO q8h

18
Q

water exposure wound with salt water rx

A

cipro 750 mg PO BID x 10 days

19
Q

fish hook removal
4

A
  1. clean wound
  2. consider digital block or local anesthesia
  3. tie suture around bend of hook
  4. exert downward pressure on shank to dislodge the barb then pull
20
Q

soft tissue concerns - when to refer to ER
4

A
  1. failed OP tx worsening after 48 hours
  2. worrisome features - breast, groin, axilla, foreign material i.e. joint replacement, graft, PICC line, crepitus (nec fasc), evidence of septic joint, rapid progression of erythema
  3. high risk comorbs - DM, recent organ transplant, immunosuppressed
  4. rabies proph
21
Q

herpes zoster is caused by what virus

A

varicella zoster virus

22
Q

herpes zoster - systemic sx are ____ common

A

less common - HA, fatigue, fever

23
Q

herpes zoster - 75% of pts have what sx
3

A
  1. prodromal pain
  2. itching
  3. tingling
24
Q

herpes zoster - 3 phases of pain

A
  1. acute herpetic neuralgia that may begin preceding rash
  2. subacute HN may persist after rash resolves but < 4 months after onset
  3. post HN (PHN) > 4 months
25
Q

disseminated zoster

A

lesions outside of primary/adjacent dermatome

26
Q

herpes zoster - rash course
4

A
  1. erythematous papules develop first
  2. then several days by vesicles or bullae
  3. rash becomes pustular on days 3-4
  4. lesions crust day 7-10
27
Q

herpes zoster - typical resolution

A

2-4 weeks, lesions may scar

28
Q

herpes zoster - what dermatomes are most common
2

A

thoracic or lumbar single dermatomes - although may appear in multiple or any dermatome

29
Q

herpes zoster - img/testing

A

characteristic appearance lowers utility of PCR testing - may need in immunocompromised pts or when dx is in question

30
Q

herpes zoster - goals of therapy
5

A
  1. lessen severity and duration of pain
  2. promote more rapid healing of lesions
  3. prevent new lesion formation
  4. decrease viral shedding to reduce transmission
  5. prevent PHN
31
Q

herpes zoster - tx usually reserved for

A

sx duration < 72 hours but can begin tx latera if new lesions are still occurring

32
Q

herpes zoster - antiviral
2

A
  1. valacyclovir 1000 mg PO q8h x 7 days
  2. acyclovir 800 mg PO 5 x day for 7 days
33
Q

herpes zoster - tx duration abx

A

7 days

34
Q

herpes zoster - pain/PHN rx
5

A
  1. analgesics - gabapentin
  2. capsaicin (Cap-say-sin) cream (OTC) - neuro pain, after lesions have healed
  3. topical lidocaine (OTC) - neuro pain, after lesions have healed
  4. opioids
  5. steroids - prednisone 10 day taper course, avoid in DM pts d/t elevated BG
35
Q

herpes zoster - pt education
3

A
  1. viral can be spread until all lesions are crusted over by direct contact or through airborne droplets
  2. iso isn’t needed but avoid individuals who are immunocompromised, pregnant people, children < 1, or varicella naive people
  3. cover lesions at all times
36
Q

herpes zoster oticus

A

involves the ears - refer to ENT as may involve facial nerve and lead to facial paralysis

37
Q

herpes zoster - when to refer to ER
3

A
  1. herpes zoster opthalmicus
  2. herpes zoster oticus
  3. disseminated herpes zoster

Urgent Care Guide (38 decks)

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