We know that ultrasonography can be used to identify soft tissue infections. But what exactly are the distinguishing features between cellulitis and abscess? Is that a foreign body? Should I put a scalpel to this soft tissue infection? This PV card, written by Drs. Alissa Genthon, Patricia Henwood, and Mike Stone, serves as a great reference card for you at the bedside.
Go to ALiEM (PV) Cards for more resources.
Case: A 41 year old male with one week of non-pruritic palmar rash that started on his trunk and spread to his hands. He has no history of travel, fever, joint pains, or medication use. What is your diagnosis for this palmar rash? Click on the image for a larger view.
Case: A pre-teen girl, living in central California, recently started on fluconazole, now presenting with a bilateral leg rash. What is your diagnosis? Click on the image for a larger view.
You are treating a patient with left lower leg cellulitis. The nurse is going to establish IV access, draw blood work, and give analgesia and antibiotics. Before walking into the room, the nurse asks, “Do you need me to grab a set of blood cultures?” Additionally the hospitalist had asked you to order a “set of cultures” on your most recent cellulitis admission. Should you proceed?
Contact dermatitis from poison oak
We see a variety of rashes in the Emergency Department. The first step is to accurately describe the rash. Is this a macule or nodule? Is this a vesicle or bulla? The next step is to quickly “profile” it to see if it fits any classic pattern by patient age, lesion distribution, or presence of hypotension. And finally, if you are still stumped, use an algorithm based on the rash type.
These figures are from March 2010’s Emergency Medicine Magazine. It’s not meant to be a comprehensive article on rashes but it sure does take the guesswork out of 90% of the rashes you see.
Go to ALiEM (PV) Cards for more resources.
Thanks to Dr. Hemal Kanzaria for including this idea as a PV card.
Burn classification and management are key skills for ED providers to remember. Depending on the prevalence of burns in your ED, it may be hard for forget the details. So here is a PV reference card on the rule of 9’s, different classifications of burns, and indications for burn unit referral.
Update (April 22, 2016): This card was updated by Dr. Christian Rose (UCSF-SFGH) to reflect current evidence that topical antibiotics and honey are IN, while silver sulfadiazine is OUT for partial-thickness burns.
Adapted from [1-3]
Go to ALiEM (PV) Cards for more resources.