Board Review: Skin Emergencies
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A man with a bullae.
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John Cafaro MD
#EMConf: Cutaneous Abscess
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Pearls from today's talk on cutaneous abscess.
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Back to Basics: Pemphigus Vulgaris
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Pathology: Chronic autoimmune mucocutaneous disease against desmosomes in epidermis
Clinical:
- painful; rarely pruritic; afebrile
- flaccid bullae but may start tense, +Nikolsky's sign
- mucosal involvement common
- Bullous pemphigus: Have tense bullae (may start with urticarial lesions), negative Nikolsky's sign, mucosal involvement less likely
Diagnosis: clinical; biopsy is gold standard.
Management:
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Board Review: Skin and Soft Tissue Infections
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A 32 year old male history of IV drug use presents for redness to his right arm extending the antecubital fossa. He has pain out of proportion to the area and pain outside of the erythematous margins. He is febrile to 103.2 F, heart rate is 125, blood pressure is 80/40. Patient is given normal saline. Vancomycin and Cefepime are started. What is the next step in management?
A. Immediate Surgical Consult and Clindamycin.
B. Draw labs to risk stratify via the LRINEC score and a CT scan
C. Immediate Surgical Consult and a CT scan.
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Board Review: Epistaxis
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A 30 year old male with no past medical history presents to the ED for epistaxis. You notice actice bleeding from right nare but cannot determine the exact source. Direct pressure was attempted for 20 minutes followed by application of a topical vasoconstrictor bleeding persists. What is the next best step in management of this patient's epistaxis?
A. Irrigation
B. Posterior Packing
C. Anterior Packing
D. Cautery with silver nitrate
Answer: C - Anterior Packing
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EMConf: Trach Dislodgement
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Dr. Emily Damuth, MD of the Department of Emergency Medicine and Critical Care at Cooper University discusses tracheostomy emergencies.
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Board Review: Dental Problems
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A 35 year old female presents to the Emergency Department with sudden onset of right lower dental pain. Patient had a dental extraction for a dental carie 5 days ago. What is the most likely diagnosis?
A. Acute Necrotizing Ulcerative Gingivitis
B. Pulpitis
C. Dental Abscess
D. Alveolar Osteitis
E. Post-Extraction Pain
Answer is D - Alveolar Osteitis (Dry Socket)
Loss of healing clot leads to pain and inflammation 3-5 days post extraction.
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#EMConf: Red Eye Pearls
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Dr. Pelletier-Bui discusses some important red eye pearls.
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Board Review: Anaphylaxis
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A 50 year old male with history of atrial fibrillation and a seafood allergy presents after eating seafood. He is on a beta-blocker for rate control. He has facial swelling, hives, trouble breathing and nausea. You give epinephrine x 2 intramuscularly but the patient is not improving. What is your next step in management.
A. Epinephrine IM
B. Epinephrine IV
C. Glucagon
D. Glucocorticoid
E. Pepcid
Answer: C - Glucagon
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