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Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C77DDF.83988BA0 Content-Location: file:///C:/2CC3308E/DermfortheERPhysician_files/slide0001.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Derm for the ER Physician
Derm for the ER Physician
The only 7 rashes you NEE= D to know
William Deaton, D.O.
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Stevens-Johnson Syndrome
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History
<= span class=3DBB style=3D'position:absolute;left:-4.44%;top:.39em'>nNew d= rug started in last few days
nPossi= bly exposure to herpes virus, influenza, hepatitis, or a fungal infection of the skin
------=_NextPart_01C77DDF.83988BA0 Content-Location: file:///C:/2CC3308E/DermfortheERPhysician_files/slide0004.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Derm for the ER Physician
Physical
nSystemic Erythema Mulitformic rash <= span style=3D'position:absolute;top:36.5%;left:8.42%;width:93.44%;height:6.75%'= >bullous lesions involving entire skin and mucus membranes ntachy= cardia, tachypnea, diarrhea, headache, and hematuria possibly present
------=_NextPart_01C77DDF.83988BA0 Content-Location: file:///C:/2CC3308E/DermfortheERPhysician_files/slide0005.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Derm for the ER Physician
Treatment
nDISCO= NTINUE the drug that started this!
<= span class=3DBB style=3D'position:absolute;left:-3.93%;top:.39em'>nConsi= der prednisone 80-120mg IV qDay
nWet c= ompress of potassium permanganate solution over lesions <= span style=3D'position:absolute;top:62.0%;left:8.42%;width:85.95%;height:6.75%'= >nOptho= consult immediately if corneal involvement
<= span class=3DBB style=3D'position:absolute;left:-4.44%;top:.39em'>nADMIT= TO ICU
------=_NextPart_01C77DDF.83988BA0 Content-Location: file:///C:/2CC3308E/DermfortheERPhysician_files/slide0006.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Derm for the ER Physician
Pathology
nSevere systemic hypersensitivity reaction
nCan b= e result of collagen-vascular disease or malignancy
------=_NextPart_01C77DDF.83988BA0 Content-Location: file:///C:/2CC3308E/DermfortheERPhysician_files/slide0007.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Derm for the ER Physician
Toxic Epidermal Necrolysis
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History
nFlu-like prodrome precipitated by new drug or blood products nSkin = becomes painful, hot, blisters develop, entire epidermis can slough= off
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Physical
nBlistering skin = with mucus membrane involvement
<= span class=3DBB style=3D'position:absolute;left:-4.44%;top:.39em'>nEntire epidermis is involved
n+Niko= lsky’s sign (skin sloughs off with very light traction) nPatie= nt can be hypotensive and hyperkalemic
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Treatment
nDiscontinue offending agent (drug or blood)
nFluids similar to burns (Parkland formula=3D 4ml/kg/%BSA burned in first 24 hours)
nTreat hyperkalemia if not resolving with fluids
nConsider Steroids
nAdmit to ICU
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Pathology
nSevere systemic hypersensitivity reaction with antibodies against the epiderma= l-dermal junction
------=_NextPart_01C77DDF.83988BA0 Content-Location: file:///C:/2CC3308E/DermfortheERPhysician_files/slide0012.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Derm for the ER Physician
Staphylococcal Scalded Skin= Syndrome (SSSS)
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ER Physician
History
<= span class=3DBB style=3D'position:absolute;left:-4.44%;top:.39em'>nAge 6= mo. To 6yrs.
nProdr= ome of fever, malaise, skin tenderness nSores beginning around mouth turning to blisters, then spreading = to rest of body
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Physical
<= span class=3DBB style=3D'position:absolute;left:-4.44%;top:.39em'>nEryth= ema and blistering of skin
nBulla= e and vesicles beginning around mouth and spreading to rest of body&= #13;
<= span class=3DBB style=3D'position:absolute;left:-4.44%;top:.39em'>n+Niko= lsky’s sign
<= span class=3DBB style=3D'position:absolute;left:-4.44%;top:.39em'>nNO mu= cus membrane involvement
------=_NextPart_01C77DDF.83988BA0 Content-Location: file:///C:/2CC3308E/DermfortheERPhysician_files/slide0015.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Derm for the ER Physician
Treatment
nNaficillin 500-100mg/kg/day IV or Dicloxacillin 50mg/kg/day PO
<= span class=3DBB style=3D'position:absolute;left:-4.44%;top:.39em'>nFluid= s
<= span class=3DBB style=3D'position:absolute;left:-4.44%;top:.39em'>nSoft = blanket wraps
nAdmit= to PICU if severe, peds floor if mild
------=_NextPart_01C77DDF.83988BA0 Content-Location: file:///C:/2CC3308E/DermfortheERPhysician_files/slide0016.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Derm for the ER Physician
Pathology
nExfoliative toxi= n of S.aureus causes granular layer of epidermis to detach and form blisters
<= span class=3DBB style=3D'position:absolute;left:-4.44%;top:.39em'>nUsual= ly from small break in skin
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Toxic Shock Syndrome
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History
<= span class=3DBB style=3D'position:absolute;left:-4.44%;top:.39em'>nUsual= ly female
nUsual= ly using tampons, not changing for extended periods of time = nCan h= ave nasal packing in place from ENT surgery
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Physical
<= span class=3DBB style=3D'position:absolute;left:-4.44%;top:.39em'>nDiffu= se blanchable, macular rash
<= span class=3DBB style=3D'position:absolute;left:-4.44%;top:.39em'>nPossi= bly have large bullae
<= span class=3DBB style=3D'position:absolute;left:-4.44%;top:.39em'>nMucus membrane involvement
nFull thickness desquamation possible in 1-2 wks nHypot= ension, renal, hepatic, or hematologic dysfunctions
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Treatment
nDrainage of infe= ction, and removal of tampon or packing
<= span class=3DBB style=3D'position:absolute;left:-3.86%;top:.39em'>nNafic= illin, Vancomycin, or Clindamycin IV
<= span class=3DBB style=3D'position:absolute;left:-4.44%;top:.39em'>nFluid replacement if hypotensive
<= span class=3DBB style=3D'position:absolute;left:-4.44%;top:.39em'>nPress= or therapy if needed
<= span class=3DBB style=3D'position:absolute;left:-4.44%;top:.39em'>nEarly steroids can be helpful
<= span class=3DBB style=3D'position:absolute;left:-4.44%;top:.39em'>nAdmit= to ICU
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Pathology
nTSST-1 exotoxin = from Staph. Aureus causing a super-antigen effect and = widespread cytokine release
<= ![if !vml]>
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file:///C:/2CC3308E/DermfortheERPhysician_files/slide0022.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Derm for the ER Physician
Meningiococcemia
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