Diagnose on Sight: Diffuse Desquamating Dermatitis

stevens-johnson syndromeCase: An 84 year old female presents with five days of a diffuse rash. She had a seizure and was started on phenytoin 2 weeks ago. Her mouth, labia, and medial canthi are involved. There are scattered areas of desquamation comprising less than a tenth of her total body surface area. She is tachycardic and febrile. Her complete blood count differential is normal. What is the diagnosis?

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By |2016-12-22T19:43:02-08:00Jun 8, 2015|Dermatology, Diagnose on Sight|

PV Card: Skin and Soft Tissue Ultrasound

Abscess Ultrasound

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.

PV Card: Skin and Soft Tissue Ultrasound


Go to ALiEM (PV) Cards for more resources.

Cellulitis: Do Not Get Blood Cultures

BloodCultureBottleYou 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?

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Paucis Verbis: Approach to rashes

Poison Oak rash

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.

PV Card: Approach to Rashes


Go to ALiEM (PV) Cards for more resources.

Thanks to Dr. Hemal Kanzaria for including this idea as a PV card.

By |2021-10-12T16:11:54-07:00Aug 26, 2011|ALiEM Cards, Dermatology|

Paucis Verbis card: Burn Wounds

burn woundsBurn 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.

PV Card: Burn Wounds

Adapted from [1-3]
Go to ALiEM (PV) Cards for more resources.

References

  1. Gómez R, Cancio L. Management of burn wounds in the emergency department. Emerg Med Clin North Am. 2007;25(1):135-146. [PubMed]
  2. Malik K, Malik M, Aslam A. Honey compared with silver sulphadiazine in the treatment of superficial partial-thickness burns. Int Wound J. 2010;7(5):413-417. [PubMed]
  3. Jull A, Cullum N, Dumville J, Westby M, Deshpande S, Walker N. Honey as a topical treatment for wounds. Cochrane Database Syst Rev. 2015;(3):CD005083. [PubMed]
By |2021-10-18T10:23:37-07:00Jul 2, 2010|ALiEM Cards, Dermatology, Trauma|
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