FOAMed

EM@3AM: Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

A 55-year-old male presents to the ED for a rash of 2-day duration. He had URI symptoms for 4 days preceding the rash with myalgias and subjective fevers. He notes the rash began as small painless, erythematous papules but has progressed to larger, tender bullae. The rash began on his trunk and has spread to his face and bilateral upper extremities. He is febrile and tachycardic. On physical exam, the rash affects close to 20% of TBSA, and with gentle rubbing, skin sloughing is noted. What is the diagnosis?

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EM@3AM: Bacterial Meningitis

A 21-year-old male is brought to the ED via EMS after a reported seizure. As per girlfriend, the patient began complaining of a headache yesterday, and today he is confused. He is febrile and tachycardic. He is confused and has nuchal rigidity. However, Kernig and Brudzinki signs are negative. CT is negative. What is most likely diagnosis, and what is the next step in diagnosis?

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