Grand Rounds: Pediatric Rashes

This week, Dr. Aaron Ruberto (otherwise known as Mr. Trebek), took us through an exciting and informative game of Jeopardy to teach us about Pediatric Rashes. The ultimate winner was Dr. Eve Purdy, but we all ‘won’ a ton of relevant and always difficult trivia regarding common and serious pediatric rashes encountered in the ED. See the infographic below as a reminder of the basics to use as an approach to these skin conditions in practice. If you have specific questions, I’m sure Aaron would be happy to provide his expert opinion.

gr-sept-29

You can download a pdf of the above summary here: Grand Rounds Sept 29.

You can also check out the following resources to practice your pediatric rashes:

Staff Rounds:

Dr. Nici Rocca presented an interesting case for staff rounds before Aaron took to the mic, reminding us to keep necrotizing fasciitis on our differential as one of the time sensitive, high mortality infections not to miss in the ED! She provided a description of a recent case she had in the ED of an older woman who presented with refractory cellulitis, pain out of proportion, and a history of femoral popliteal bypass. She reminded us of the risk factors (diabetes, vascular insufficiency, trauma, etc.), the physical exam (pain out of proportion, induration beyond visible cellulitis, crepitus, erythema, bullae, necrosis ecchymosis), and the importance of rapid referral to a surgeon as definitive treatment. Imaging can be done but should not delay treatment – CT or MRI are best. Piptazo + Vancomycin OR Clindamycin + Ampicillin + Vancomycin are good empiric regimes to start in the ED. Penicillin + Clindamycin can be used if you are sure it is a type 2 monomicrobial infection with streptococcus! In the end the patient above ended up having a graft infection for which she was placed on antibiotics and taken to the OR to remove the infected graft and repeat her bypass.

Author: Kristen Weersink

PGY2 with interests in medical education, all things emergency medicine and getting outside whenever possible.

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