Contributor: Peter Bakes, MD Educational Pearls: Mild frostbite injury usually only requires supportive care In severe frostbite injury, patients should receive an immediate angiogram, be admitted, and receive tPA if there is evidence of vascular occlusion Salvage rate is around 80% for appropriate patients who receive tPA in phalangeal frostbite injury References Paine RE, Turner…
Read MoreContributor: Chris Holmes, MD Educational Pearls: Parkland Formula: 4 mL x [Total Body Surface Area Burned (%)] x [body weight (kg)] given in 24 hours 50% given over 8 hours and 50% given over the next 16 hours Brooke Formula: 2 mL x [Total Body Surface Area Burned (%)] x [body weight (kg)] given in…
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mr. freeze Chief Complaint: Painful wounds on skin for months HPI: 32-year-old male with past medical history of alcohol use disorder and general anxiety disorder presents with painful skin wounds to the right thigh for approximately four months. He curbed his cravings for EtOH with inhalant use. He uses keyboard duster cans several times a…
Read MoreContributor: Jared Scott, MD Educational Pearls: Hand eczema is present in about 10% of the population and has a great prevalence in hairdressers, healthcare workers, and food service employees Using 1% oatmeal cream instead of a base cream showed statistically significant improvement in outcomes of HE in healthcare workers in a double-blind study References Sobhan…
Read MoreContributor: Ricky Dhaliwal, MD Educational Pearls: Primarily affects children <6 years old and adults with kidney disease Caused by staph aureus releasing exotoxins that result in erythema and sloughing of the skin Present with significant pain, dehydration and underlying staph infection Treatment typically oxacillin/nafcillin with admission for wound care with petroleum gel and xeroform Burn…
Read MoreContributor: Peter Bakes, MD Educational Pearls: Lyme disease gives a single expanding target lesion with central clearing called erythema chronicum migrans Erythema multiforme is another targetoid rash that presents with multiple target lesions Characterized into erythema minor and major based on severity but typically resolves More severe hypersensitivity reactions include Stevens-Johnson Syndrome (<10% skin involvement),…
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should have ordered in Chief Complaint: Hand Burn HPI: 23-year-old right hand dominant male presenting to the emergency department for a burn to the left hand which he sustained just prior to arrival. He reports that he was frying chicken when the oil started on fire. In a panic, he ran with the pan outside…
Read MoreContributor: John Winkler, MD Educational Pearls: Swimmers itch is due to a flatworm parasitic infection that causes an itchy rash after the worm burrows into the skin The flatworm is passed between bird and snail hosts The itch is due to the death of the parasite under the skin which leads to an extremely itchy…
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Calcium burns Chief Complaint: Calcium Burns HPI: 46 year old male with past medical history of ESRD on HD, hypertension, congestive heart failure and secondary hyperparathyroidism underwent a subtotal parathyroidectomy without complications 18 days ago. Pt had extravasation of IV calcium chloride infusion to his right forearm 17 days ago; hand surgery was consulted and…
Read MoreBurns are low-volume, high-acuity injuries that require special attention and care from the pre-hospital team to the Emergency Department and finally to a dedicated burn unit and ICU. As a first responder in the pre-hospital setting, there are a couple things that need to remain at the forefront of your mind when dealing with burn…
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