Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
142 Cards in this Set
- Front
- Back
- 3rd side (hint)
|
History includes
|
SAMPLE +
FRIENDS (FH, family/friends hx, Records & ROS, Immunizations, EMS personnel as source of info, Narcotic and substance abuse, Doctor for admission/consult, Social history with living environment) |
|
|
|
Secondary survey includes
|
General, HEENT neck, lungs/chest, heart, abd, gu-perineum, rectal/vagina, pelvis, extremities, neuro, vascular, skin
|
|
|
|
Airway includes
|
immobilize cspine and place in hard collar and backboard with foam blocks and anchor chin and forehead straps
|
|
|
|
Breathing includes
|
possibly put on O2, treat tension/open PTX, place on oximeter, reassess after procedures
|
|
|
|
Circulation includes
|
skin exam for color, rash, petechaie, pulse rate and regular, cap refill, bp, find and countrol bleeding. Includes 2large IV's and possibly IVF and cardiac monitor. Order ABG and labs, EKG, xrays, DONT, tetanus
|
|
|
|
Coma protocol
|
Thiamine 100mg IV
Narcan 2mg IV in adult or 0.1mg/kg pediatrics Glucose 50-100ml D50W adults and 2-4mL/kg of D25W for 0.5-1g/kg for pediatrics 1mo-8yo and use 0.5-1g/kg of D10W for neonates. |
|
|
|
Exposure includes
|
undress, look for medical tags and personal information in wallet, prevent hyperthermia
|
|
|
|
Finger and Foley
|
Check for contraindications to place foley and put finger in every orifice
|
|
|
|
Gastric
|
place NG but check for contraindication to NGT
|
|
|
|
All patients with chest pain require a....
|
rectal
|
|
|
|
All patients who require thrombolysis have...
|
contraindication
|
|
|
|
All children are...
|
abused
|
|
|
|
All heart patients given morphine/ntg...
|
will be come hypotensive
|
|
|
|
All alcoholics have....
|
multiple problems
|
|
|
|
All pills are...
|
somewhere
|
|
|
|
All seizure patients...
|
dislocate something
|
|
|
|
All patients who require thrombolysis have...
|
contraindication
|
|
|
|
All patients with overdose...
|
are real and need psych consult
|
|
|
|
All children are...
|
abused
|
|
|
|
All joints are...
|
septic-check for overlying cellulitis
|
|
|
|
All heart patients given morphine/ntg...
|
will be come hypotensive
|
|
|
|
All patients with ALOC need....
|
have fallen and need Ccollar and backboard-replace all soft collars
|
|
|
|
All alcoholics have....
|
multiple problems
|
|
|
|
All patients with abnormal temperature need...
|
rectal probe
|
|
|
|
All pills are...
|
somewhere
|
|
|
|
All seizure patients...
|
dislocate something
|
|
|
|
All patients with overdose...
|
are real and need psych consult
|
|
|
|
All joints are...
|
septic-check for overlying cellulitis
|
|
|
|
All patients with ALOC need....
|
have fallen and need Ccollar and backboard-replace all soft collars
|
|
|
|
All patients with abnormal temperature need...
|
rectal probe
|
|
|
|
All seizure patients are...
|
noncompliant with meds
|
|
|
|
All single encounter patients...
|
need admission
|
|
|
|
All burns have...
|
CO poisoning
|
|
|
|
All pain that goes away will...
|
be replaced with s/t else
|
|
|
|
All patients who have an arrhythmia will....
|
eventually need to be shocked.
|
|
|
|
All patients with "the flu" have...
|
CO poisoning, toxin ingestion, dangerous infection
|
|
|
|
All kidss <3mo...
|
w/u for sepsis
|
|
|
|
All females are...
|
pregnant
|
|
|
|
All patients who wake up with D50 will need...
|
admission
|
|
|
|
All patients with PTX need...
|
quick needle decompression
|
|
|
|
All trauma and burn patients are at risk for...
|
myoglobinuria--order ua on all burn and trauma patients
|
|
|
|
All females of child-bearing age with abd pain have....
|
ectopic pregnancy
|
|
|
|
All children with head injury have...
|
hemophilia
|
|
|
|
Hemophilia
|
Sex-linked recessive
A is F8 defic B is F9 devic (Christmas disease) Bleed usually into weight bearing joints (knees>elbows>ankles and leads to chronic arthropathy and joint destruction), soft tissue, muscle. Bleeding often delayed hrs-days and may cont hrs-days from onset Can get psoas/retroperitoneal hematoma if hip pain/LQ pain or psoas sign. Spon hematuria. ICH 25% deaths. Trauma worry compartment syndromes, neck, retropharynx, pharynx, airway compromise, delayed/protracted bleeding after dental extractions/mild trauma Have normal bleed time, plts, PT; have prolonged PTT |
Treatment:
Rx before HCT if suspect ICH Hemophilia A 1U F8/kg->2% rise in factor activity. DDAVP: Very mild bleed 0.3mcg/kg vs 18U/kg in mild bleed and 26u/kg moderate and 50u/kg Hemophilia B: 1U F9/kg (1% rise in factor) FFP very minor bleed 15-20cc/kg but F9 still atgent of choice. Inc 10-20% mild, 30-50% moderate, >50% if major No blood thinners, avoid contact sports, recognize early, ortho and PT referral Must immobilize hemarthrosis. |
|
|
Parkland formula
|
weight (kg) x 4ml = 24hr total (give 1/2 first 8hrs and then 1/2 over other 16hrs)
Don't forget IVF maintenance |
|
|
|
ETT
|
(16+age) / 4
|
|
|
|
Pediatric weight
|
(age +3) + 6
|
|
|
|
Pediatric SBP
|
<1yo: <90
>1yo: 80 + (2xage) = SBP Diastolic BP= 2/3 SBP |
|
|
|
Pediatric bolus fluids and blood
|
20cc/kg
10cc/kg |
|
|
|
Pediatric maintenance fluid
|
4cc/kg/h first 10kg
2cc/kg/h second 10kg 1cc/kg/h every kg over 20 |
|
|
|
Foley cath and NGT size
|
0-5yo 5F
8yo 8F 10yo 10F 12yo 12F |
|
|
|
Chest tube size
|
0-6yo: 10-20F
6-10yo: 20-30F 10-12yo: 30-38F |
|
|
|
APGAR
|
0-2
Appearance (pink, acrocyanosis, blue) Pulse (>100, 50-<100. <50) Grimace (present, weak, none) Activity/tone (good, mild, none) Resp effort (good, weak, none) |
|
|
|
Dose lidocaine
|
1-1.5mg/kg push every 5-10min then in Vtach or wide complex tach use 0.5mg/kg to max total of 3mg/kg IV push
|
|
|
|
Procainamide dose
|
20-30mg/min to max 17mg/kg (give after lido fails or in WPW)
|
|
|
|
Amio dose
|
300mg IV over 10min if no pulse otherwise 150mg over 10 min then 1mg/min x6hrs
|
|
|
|
Adenosine dose
|
6mg IV over 3sec
2min later 12mg IV over 3sec 2min later 12mg IV over 3sec |
|
|
|
Verapamil dose
|
2.5-5mg IV and repeat in 15-30min
|
|
|
|
What u/s use for transvenous pacer placement
|
2-3.5mHz subxiphoid
|
|
|
|
What size pacemaker
|
4Fr, have spare 9V battery, must be on EKG to evaluate lead V
Check balloon b/f insert |
|
|
|
How far insert pacemaker
|
10-12cm then advance slowly until in RV as p smaller and QRS much bigger, blow up balloon and advance 2-3cm further with tip flickering across tricuspid then deflate balloon and float 5-10cm more.
|
|
|
|
Diltiazem doses
|
PSVT: 20mg (0.25mg/kg) IV over 2 min then after 15min 25mg (0.35mg/kg) direct IV if first dose tolerated but response inadequate, possibly can give additional doses Q15min
Afib/flutter 20mg (0.25mg/kg IV over 2 min then 25min (0.35mg/kg) direct IV if first dose tolerated but response inadequate. Can add additional doses Q15min per some. Maintenance is usually 10mg/hr IV infusion to NMT 15mg/hr up to 24h Dont uses in 2/3rd degree heart block, WPW, Lown-Ganong-Levine Syndrom, shypotension/cardiogenic shock, VTach, don't use in newborns |
|
|
|
Digoxin dose
|
Load 0.4-0.6mg IV x1 then 0.1-0.3mg Q6-8h to 0.008-0.015mg/kg total.
Therapeutic serum range 0.5-2ng/mL with target 0.5-1ng/mL Dont give in Vfib or hypersensitivity Less effective if low K or low Ca. Serum levels drawn w/i 6-8h of dose will be falsely high due to prolonged distribution phase Use for afib/flutter and CHF |
|
|
|
Joules to cardiovert afib
|
100J sync then 200, 300, 360J
|
|
|
|
Joules to cardiovert aflutter
|
50J
|
|
|
|
Medications to treat pheochromocytoma
|
phentolamine, niptride, labetalol, replace K, admit ICU w/ endocrine if symptomatic
Sx: 20-45 yo with severe HTN, HA, palpitations, diaphoresis, +/-CP, N/V, tachy, ortho hypotension, hyperglycemia, wt loss. |
|
|
|
Medications to treat pheochromocytoma
|
phentolamine, niptride, labetalol, replace K, admit ICU w/ endocrine if symptomatic
Sx: 20-45 yo with severe HTN, HA, palpitations, diaphoresis, +/-CP, N/V, tachy, ortho hypotension, hyperglycemia, wt loss. |
|
|
|
Standford A vs B
Debakey I, II, III |
Standford A is ascending aorta (I&II)
Stanford B is descending aorta (III) I=ascending + descending II=ascending III=descending A surgical, B medical |
|
|
|
Dissection esmolol gtt
|
500microg/kg IV over 1 minute
Then infuse 50microg/kg/min |
|
|
|
Dissection propranolol
|
1mg/min to total of 10mg
|
|
|
|
Dissection nitroprusside
|
0.5microgram/kg/min IV to SBP 100-120
|
|
|
|
Lytics in MI:
Contraindications |
active GI bleed
prolonged CPR >10min intracranial aneurysm/AVM/tumor h/o hemorrhagic CVA intracranial/spinal surgery trauma within 2 months Active internal bleeding Suspected dissection/pericarditis Relative contraindications: h/o CVA, coagulopathy, recent surgery/trauma>180/100, current anticoag w/ INR 2-3, known bleeding diathesis, CPR>10min, major surg w/i 3weeks, noncompressible vasc puncture (SC/IJ CVC), prior streptokinase shouldn't get streptokinase, prego, active PUD |
|
|
|
Alteplase (tPA) dose MI
|
>67kg: 15mg initial bolus then 50mg infused over next 30min, 35mg infused over next 60min.
<67kg: 15mg initial bolus, 0.75/mg/kg infused over next 30 min, 0.50 mg/kg infused over next 60minutes. Max dose 100mg |
|
|
|
Streptokinase dose MI
|
1.5million units over 60minutes
No heparin required. |
|
|
|
Nitroglycerin IV for MI
|
5mcg/min and inc 5mcg/min Q3-5min up to 20mcg/min then inc by 10mcg/min; max generally 100mcg/min
|
|
|
|
Dose of GP2B/3A inhibitor
|
Abciximab
0.25m/kg IV bolus |
|
|
|
Treatment acute pulmonary edema from MI
|
Keep O2 >90% (poss intubate)
Furosemide 1mg/kg IV Morphine 2-4mg IV Nitroglycerin SL then IV 10-20mcg/min if SBP>90 Second line: SBP<70, norepi 0.5-30mcg/min IV SBP 70-100, dopamine 5-15mcg/kg/min IV; if no signs of shock can use dobutamine 2-20mcg/kg/min SBP >100 use nitroglycerin 10-20mcg/min IV SBP>100 and not <30 mm Hg below baseline captopril 1-6.25mg po 3rd line: intra-oartic balloon pump, angio, reperfusion |
|
|
|
Indications for intubation
|
RR>40, excessive use accessory muscles, pO2 <100 on 40% O2, pCO2 >50, decreased mentation, GCS <8, trauma patient w/ potential upper airway obstruction and/or burns, apnea, loss of airway protective reflexes
|
|
|
|
Indications for cricothyrotomy
|
Immediate airway management in patient whom oral/nasal intubation contra or can't be done. Required for maxillofacial/laryngeal trauma, upper airway obstruction, or cspine precautions
|
|
|
|
Absolute contra to cricothyrotomy
|
<12yo ,coagulopathy, transection of trachea w/ retraction of distal end into mediastinum, fx larynx, easy ET intubation in absence of contraindications
|
|
|
|
How perform cricothyrotomy
|
Neutral position w/ cspine immobiliztion or extend neck if no risk cspine injury, ID cricothyroid membrane, make 2cm transverse skin incision thru membrane into trachea, dilate opening, insert tracheostomy tube/ETT
|
|
|
|
Complications of cricothyrotomy
|
hemorrhage, infection, subcutaneous/mediastinal emphysema, PTX, lac trachea/esophagus, subglottic/laryngeal stenosis, prolonged hypoxia, create paratracheal tract, R mainstem bronchus intubation
|
|
|
|
Adv of cricothyrotomy over tracheostomy
|
Easier, faster, doesn't require OR, manipulations of neck aren't as much, decreases incidence of early/late complications
|
|
|
|
Complication rate of ER cricothyrotomys
|
10-40%
|
|
|
|
#1 complications of ER cricothyrotomy
|
Bleed, unsuccessful tube placement, prolonged procedure time.
|
|
|
|
#1 cause of subglottic stenosis
|
ETT intubation, not cricothyrotomy/tracheostomy.
|
|
|
|
How is a needle cric performed
|
insert 14g IV cannula thru inferior part of cricothyroid membrane with needle at 45degree angle to skin and oriented caudad. Once in trach, insert cath and convirm by aspirating air with syringe, ventilate 1 sec and allow exhale over 4 sec.
|
|
|
|
Indications for needle cric
|
Orotracheal/nasotracheal intubation can't be performed, when intubation can't be performed in timely manner, intubation contra, when temporary relief of hypooxemia is req b/c of airway obstruction
|
|
|
|
Absolute contra to needle cric
|
When ETT intubation not contra, when trachea transected/retracted, when direct damage to cricoid cartilage/larynx
|
|
|
|
#1 complication of percutanelus translaryngeal ventilation
|
Subcutaneous emphysema
|
|
|
|
Indications for needle cric
|
Orotracheal/nasotracheal intubation can't be performed, when intubation can't be performed in timely manner, intubation contra, when temporary relief of hypooxemia is req b/c of airway obstruction
|
|
|
|
Absolute contra to needle cric
|
When ETT intubation not contra, when trachea transected/retracted, when direct damage to cricoid cartilage/larynx
|
|
|
|
#1 complication of percutanelus translaryngeal ventilation
|
Subcutaneous emphysema
|
|
|
|
HTN ER with MI
|
ue ntg infusion or labetalol
|
|
|
|
HTN ER With CHF
|
nitroprusside/ntg
|
|
|
|
HTN ER with eclampsia/preeclampsia
|
hydralazine/labetolol
|
|
|
|
HTN ER MAOI with food/drug
|
phentolamine/labetolol
|
|
|
|
HTN ER with RF
|
labetolol/nitroprusside
|
|
|
|
HTN ER with anti-HTN withdrawan
|
labetolol/nitroprusside
|
|
|
|
HTN ER with cocaine
|
benzodiazepines
|
|
|
|
Dose labetalol in HTN ER
|
20mg IV may repeat Q15min to adequate response to max 300mg then gtt at 2mg/min
|
|
|
|
Dose hydralazine HTN ER
|
5-15mg bolus
|
|
|
|
Dose ntg infusion HTN ER
|
50-100microg/min
Preferred for MI May have undersirable reflex tachycardia |
|
|
|
Dose Nitroprusside HTN ER
|
0.5-10 microgm/kg/min (not in pregnancy)
Invasive monitoring suggested |
|
|
|
Dose nifedipine HTN ER
|
10-20mg capsule Q20-30min
|
|
|
|
Dose Phentolamine HTN ER
|
5mg Q5-15min
May cause angina/tachydysrhythmias Use predominantly for catecholamine crisis |
|
|
|
End organ damage of HTN ER
|
RF
Encephalopathy ICH/stroke Aortic dissection Acute pulmonary edema MI/ischemia Malignant/accelerated eclampsia |
|
|
|
Check medications for HTN ER for
|
antiHTN medication w/drawal, MAOIs, tyramine (wine, cheese, beer, pickled herring), ephedrine, diet pills, cocaine, sympathomimetics
|
|
|
|
Goal BP in HTN ER
|
decrease BP to level normal for given pt within range of minutes to 1 hour. If stable, initial reduction should be followed by further reduction toward total of 160/100 within 2-6hrs with gradual reduction to normal over next 8-24h if stable.
|
|
|
|
Dose enalapril HTN ER
|
1.25-5mg IV Q6h
|
|
|
|
Dose esmolol HTN ER
|
load 500mcg/kg over 1 minut then infuse 50-200mcg/kg/min (must rebolus when escalating dose)
|
|
|
|
Dispo HTN ER
|
ICU bed
|
|
|
|
HTN encephalopathy
|
when bp > limits of autoregulation of BBB and blood enters brain tissue causing cerebral edema
|
|
|
|
HTN ER eye exam looks for
|
retinal hemorrhages and papilledema
|
|
|
|
W/u tof HTN ICH
|
CBC, SMA7, coags, +/-troponin, UA, EKG, HCT
|
|
|
|
Tx HTN ICH
|
ABC, IV, O2, monitor, treat BP>220/130 with nitroprusside then labetolol, reverse coumadin
|
|
|
|
Dose nitroprusside with HTN ICH
|
0.5 microgm/kg/min titrate to diastolic 80-100 but don't overshoot
|
|
|
|
Dose labetolol with HTN ICH
|
20mg IV over 2 min then bolus 40mg then bolus 80mg Q10min to total of 300mg then gtt at 2mg/min.
|
|
|
|
How to reverse coumadin
|
Vitamin K-1 (phytonadione) 10mg at 1mg/min IV Q6-8h (rapid IV can cause fatal anaphylaxis), po may be superior to SC/IM/IV
FFP 2-4U in adult or 15mlKg |
|
|
|
Westermark's sign
vs Hampton's hump |
Westermark's: the dilation of the pulmonary arteries proximal to the embolus and
the collapse of the distal vasculature creating the appearance of a sharp cut off on chest radiography. Hampton's: a wedge shaped, pleural based consolidation associated with pulmonary infarction |
|
|
|
Xray findings of PE
|
Elevation of hemidiaphragm
Westermark's (vasc loss) Hampton's hump (wedge) |
|
|
|
FAST U/S components
|
R hemithorax, Morrison's, R pericolic gutter, L hemithorax, subdiaphragmatic space, splenorenal, L paricolic gutter, pelvic cul de sac. +/- cardiac and PTX
|
|
|
|
San Francisco Syncope Rules
|
CHESS (any positive is high risk)
H/o CHF Hct<30% EKG abnl SOB hx SBP<90 on arrival |
|
|
|
Toxicodendrom Dermatitis
|
-Poison sumac 7-13 leaflets/leaf
-Poison ivy/oak v / u shape with 3 leaflets per leaf -Sx 1-10d after exposure Severe use domeboro compresses TID, K permanganate baths, prednisone 40-60mg initial taper over 2-3wks |
|
|
|
HSP triad
|
1) Rash 100% (purpuric, symmetri, most prominent on LE initially urticareal edematous and progress to palpable purpura
2) Arthralgia (82%) transient, ankles & knees, no permanent joint damage 3) Abd pain (63%): usually w/i 8d of onset of rash, may occur wks later, colicky, often vomiting, GI bleed common, rare findings of intusussception/pancreatitis/cholecystitis/acute scrotal edema; get u/s as needed to r/o torsion and intusussception 4. Renal disease: HSP causes 15% of all childhood glomerulonephropathies with hematuria/proteinuria and usually seen days-4wks after systemic sx palpable purpura, arthritis, abd pain, nephritis; 4-11yo; usually spring or after an infection palp purpura begins in gravity dependent areas legs/butt and extensor surfaces of arms; edema may be present of face and ears. Diffuse abd pain and arthritis may be present |
|
|
|
HSP Rx
|
1. resolves in 1-4mo
2. anti-inflammatory agents for fever and arthritis 3. treat with corticosteroids prednisone 1-2mg/kg/d for angioedema and severe GI sx including pain/bleeding, severe edema, neuro involvement, persistent nephrotic syndrome; steroids don't help alleviate lesions D/c home unless RF, secondary infection of vasculitis lesions, or intestinal tract perforations, GI bleed, sig abd pain, marked renal insufficiency |
|
|
|
TTP labs
|
Smear with fragmented RBCs-schistocytes
Retic count high LDH and bili high Platelets low UA with RBCs Nl coags and no evidence DIC |
|
|
|
Treatment TTP
|
1. ER plasmaphoresis coupled with FFP infusion until platelets normalized and hemolysis ceased
2. Methylprednisolone 1mg/kg/d IV 3. No platelets unless uncontrolled hemorrhage as can aggravate thrombosis 4. Antiplatelets (asa and plavix) are controlversial 5. splenectomy 6. ICU admit |
|
|
|
Sx TTP
|
fever, AMS, renal insufficiency, microangiopathic hemolytic anemia
|
|
|
|
RF's for TTP
|
pregnancy, estrogen, cancer, HIV, meds (quinine, anti-plts, immunosuppressants), hemorrhagic E coli
|
|
|
|
Sx TTP
|
fever
change in mental status renal insufficiency microangiopathic hemolytic anemia w/ bruising FLAT purpura (nonpalpable) |
|
|
|
ITP symptoms
|
petechiae-ecchymosis
epistaxis GIB hematuria retinal hemorrhage ICH |
|
|
|
ITP pathology
|
IgG antiplatlet antibody attacks platelets.
Chronic in adults (consider autoimmune and lymphoma and spontaneous remission uncommon, ~F 20-50yo, no prodrome Acute 2-6yo kids after viral prodrome |
|
|
|
ITP treatment
|
Acute:
-IVIG 1-2g/kg single dose -Prednisone 1-2mg/kg/d for 4 weeks then taper -Consider splenectomy Chronic: Prednisone 60mg/d 4-6wks then taper. High dose IV gamma globulin in some emergencies All: Aspirin contra Heme consult Admit if plt <20,000 or bleeding |
|
|
|
SSSS
|
-Primarily kids 6mo-6yoprodrome fever, malaise, skin tender, bullae (Sterile)
-sandpaper rash, >flexor creases, +nikolsky, spares mucus membranes -outbreaks in nursery/daycare->encourage hygiene -Exotoxin of staph aureus -Cx nose/oralpharynx, search for focus (throat, eyes, kin, umbilicus) -Tx: pain meds, nafcillin 50-100mg/kg/d IV; allergic then macrolide, IVF. |
|
|
|
Tx SSSS
|
Naficillin 50-100mg/kg/d IV
Can use dicloxacillin 2nd line macrobid IVF Pain meds No steroids!!! |
|
|
|
TEN
|
Primarily adults, skin sloughs in large sheets, form of erythema multiforme, mortality >50%
-flulike prodrome precip often by drugs/blood products -skin painful, hot, red, blisters and sloughing with +nikosky's and +mm involved, entire thickness of skin desquamates W/u: bx Tx: remove agent, IVF, lytes, burn care, derm and opthal consult, steroids controversial, burn care with Ag nitrate wet dressings (avoid silver sulfadiazine), morphine, empiric ABx SJS when <10% BSA affected and TEN when >30% BSA Assoc w/ sulfas, ABx, antisz, NSAID, TB drugs |
|
|
|
Tx TEN
|
ABC, IV, O2, monitor
Discont offending agent Pain meds Empiric ABX if signs infection/sepsis Burn care (silver nitrate (0.5%) wet dressings and avoid silver sulfadiazine, +/- steroids, +/- plasmaphoresis to remove offending drug x3d, poss surg debridement, eye irrigation for conjunctivitis, peridex IVF, lytes, Admit burn unit |
|
|
|
TSS cause and criteria
|
Staph endotoxin>strep
Criteria: Fever >38.9C/102, hypotension, rash, >3 systems involved if staph vs >2systems if strep Involves MM Other sx: diarrhea, HA, arthralgia, HA, vomiting Rash: blanches, macular erythrodermal diffuse, pharyngitis, conjunctivitis, vaginitis Can have heme/renal/hepatic dysfunction Desquamates 1-2wk and lose nail/hair 1-2mo later |
|
|
|
TSS w/u
|
Cultures, CBC, SMA7, LFT, Coags, calcium
|
|
|
|
TSS tx
|
clindamycin (also naficillin/vanco can use), steroids, +/-dopamine, remove fbo and/or drain wound
-r/o RMSF, VDRL |
|
|
|
SJS
|
vesicobullous disorder, probably drug induced and may be reaction to infection
NOT Erythema Multiforme Major (separate than SJS and TEN) ~9-14d s/p inciding drug, prodrome in 1/3, symmetric rash on face/trunk->extremities (vs EM -Mucosal involvement may precede skin lesions -Ask about any new med in last 2mo PE: red/purpuric, symmetric macules, face/trunk->abd, extremities (vs extremities to face in EM) Labs: basic labs, ESR, LFT's, Cultures, CXR of if resp involvement, Tx: ABC, IV, O2, monitor, thermal burns (no silver sulfadiazine, IVF, resp care, pain meds, empiric ABX, +/-steroids -consult opthal, derm, surg -inc risk in family and may prophylaxic them |
|
