emDOCs Revamp: DRESS
emDOCs Revamp looks at DRESS.
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rash
EM@3AM: Impetigo
A 9-month-old male presents with a rash and fever for 4 days. Mom reports the rash began in the axillae and groin and spread to the trunk. She notes the rash started as small, erythematous lesions that have progressed to bullae which are unroofing. The rash is associated with intermittent fevers (Tmax of 102°F) and diarrhea. The patient’s vital signs include T 101.2F, BP 93/56, HR 163, RR 40, SpO2 of 99% on room air. On physical exam, the patient appears pale with a prolonged capillary refill. His skin exam is significant for an erythematous rash with scattered ruptured bullae with brown crust and a collarette of scales across the trunk, axillae, perineal and flexural thigh areas. What is the diagnosis?
EM@3AM: Monkeypox
A 26-year-old female patient comes to the ED with an 8-day history of progressive weakness, fevers, and body aches. She reports that 4 days ago she noticed “bug bites” on her face, neck, arm, and hands. Sixteen days ago, she returned from a trip to Los Angeles where she shared a bed with her friend who was ill and had a rash at the time. The patient’s medical history is unremarkable, and she takes no medications. She is in a monogamous relationship with her long-term boyfriend and uses condoms consistently. Her temperature is 38.1º C (100.6ºF). Examination shows bilateral anterior cervical lymphadenopathy, and the lesions appear to be papular in appearance. The lesion resembles others on her face, neck, right upper arm, and other hand. What is the most likely diagnosis?
Dermatologic Findings in COVID-19
Not only can SARS-CoV-2 affect the respiratory, GI, CV, and neuro systems, but recent reports describe several different types of skin findings. This post breaks down several of the more common rashes in COVID-19.
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Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Mimics – Differential Diagnosis and Initial Management
Stevens-Johnson syndrome and toxic epidermal necrolysis are life-threatening diseases, but what else can mimic these dangerous conditions?
Cleavon MD – SICCC GERMS
We are proud to introduce you to Dr. Cleavon Gilman, originator of CleavonMD. Cleavon is a current emergency medicine chief resident who uses narrative music to highlight clinical conditions and social issues such as burnout, gun violence, and immigration. For his first post, emDocs features SICCC GERMS!
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Toxic Shock Syndrome: Keys in Diagnosis and Management
The patient with flu-like illness and diffuse erythroderma who appears sick… What should you consider? Could it be toxic shock syndrome? This post provides keys in the evaluation and management of toxic shock syndrome, as well as a downloadable handout.
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DRESS: What does the emergency physician need to know?
What is DRESS syndrome, and when should you consider this condition? This post evaluates this disease and provides key pearls and pitfalls.
DRESS: What does the emergency physician need to know? Read More »
Staphylococcal toxic shock syndrome: EM-focused highlights
Toxic shock is a difficult diagnosis, unfortunately often missed. If not diagnosed, the disease can result in significant mortality. This post evaluates pearls and pitfalls in the evaluation and management of this dangerous disease.
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Don't be RASH: Emergency Physician's Approach to the Undifferentiated Lesion
Editor’s note: This post was listed in both the #FOAMED Review from EM Curious AND in the LITFL Review 154 “Best of #FOAMed” section.
As an EM physician, it is difficult to have working knowledge of the hundreds of different types of rashes that exist. However, I argue that it is not the job of the EM physician to diagnose every rash that comes in the ED. That is the job of the dermatologist who has the luxury of time and biopsies. Rather, it is our duty, just like chest pain and syncope, to rule out the life-threatening causes of skin lesions, quickly identify a potentially lethal rash, and provide the appropriate initial stabilization, resuscitation and disposition (ICU, surgery).Don't be RASH: Emergency Physician's Approach to the Undifferentiated Lesion Read More »