UCONN Emergency Medicine Interest Group

Posts Tagged ‘dermatology’

EM Images #10

In IMAGES on February 25, 2012 at 11:11 AM

Syndicated from the UCONN EM Residency website; credit to Dr. London for images and text.

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A simple question: what is the diagnosis for these patients?

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EM Images #7

In IMAGES on September 12, 2011 at 3:46 PM

Syndicated from the UCONN EM Residency website; credit to Dr. London for images and text.

Scenario: a 47-year-old gentleman came for a follow-up visit for positive blood cultures. He had been seen 2 days earlier with a past medical history of asthma and the history that approximately two weeks earlier he had been at a campfire where apparently someone nearby was burning poison ivy. Immediately he had broken out in a rash on his hands and neck and face and all areas that were exposed and not covered by clothes. He also noticed that his symptoms of cough and shortness of breath increased after that incident. He then came to HHED where he had had blood cultures, an x-ray that showed pneumonia and had been discharged on azithromycin. His blood cultures were positive for Staph and he had been requested to return to the ED. His physical exam showed some inspiratory râles in the LLL where the infiltrate had been and some expiratory wheezes throughout. After treatment had been initiated in the ED, prior to admission, he developed another skin eruption, seen in accompanying photograph.

What was the treatment and what is this reaction? (click below to see answers below the fold)

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EM Images #6

In IMAGES on August 13, 2011 at 7:22 PM

Syndicated from the UCONN EM Residency website; credit to Dr. London, Dr. Bolton, Dr. Hitesh Shah for images and text.

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History:
A 25 year old male presented to HH ED in May 2009 complaining of 5 days of an itchy, scattered, worsening rash over his entire body. The rash began on his back and scalp, then spread to his arms, and is now everywhere. He was seen at a nearby clinic 5 days ago and sent home with Benadryl and Hydrocodone. He saw the PMD again 2 days ago and was also given Prednisone, Keflex, Permethrin, and Triamcinolone without relief. The rash was pruritic; he reported a sore throat and dysphagia from pain of oral lesions. He denied fever, cough, SOB, URI, conjunctivitis, congestion, runny nose, difficulty breathing, sick contacts, alleviating factors, exacerbating factors. Pt is an immigrant from Honduras and lives with his parents and his 1 year old child; he has been in the US for 4 years.

Physical Exam:
Vital Signs –T 98.2, P 111, R 16 –BP 146/89, O2 Sat 98%
Gen: Hispanic male, sitting, NAD
HEENT: NC/AT, MMM, PERRL, sclera anicteric, – JVD/LAD
Chest: Tachycardic, + S1/S2, CTAB
Back: No CVAT
Abdomen: + normoactive BS, soft, NTND, no r/g/HSM
Neurological: Awake, alert, oriented, cogent, nonfocal, MAE
Extremities: wwp, no c/c/e
Skin: see images

What is the diagnosis?

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EM Images #3

In IMAGES on June 10, 2011 at 9:34 PM

Syndicated from the UCONN EM Residency website; credit to Dr. London for images and text.

This is a case of a 13 year old otherwise healthy female who presents to the ED with a rapidly progressive rash over the past 2 days which initially started on her trunk and then spread to her extremities. There is no face, neck or mucosal involvement. The rash is pustular rather than vesicular and is follicular in distribution. This came on several days after going in a hot tub which was newly opened for the season. She is fully vaccinated for varicella.

What is the first-line treatment for this disease?

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