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Case Conference - Dr. Kiefer

5/7/2015

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Picture
Case 1: Tattoo Reactions
  • Allergic Reactions usually from red dye pigment
  • Light reactions usually from yellow dye pigment
  • Can be range of severity from granuloma or erythema to frank ulceration to anaphylaxis
  • Treatment: Attempt topical steroids.  Usually requires removal.  Caution: warn patients they can have anaphylactic reactions during removal as pigment is dispersed, consider EPI Pen!


Case 2: Missed Central Cord Injury in Intoxicated Motor Vehicle Collision

  • Sign out of trauma patients must include concerns and expectation of complete tertiary survey
  • Take “drunk patient, just needs to sober up” out of vocabulary when transferring care
  • Pre-existing spondylosis is MAJOR risk factor for central cord injury even after mild trauma. I.E. Fall from standing.  Don’t assume neurological complaints are pre-existing.
  • Treatment: Collar and admission to ensure no worsening of neurologic function.  This is an evolving injury!

Case 3: Secondary Syphilis

  • Classic are copper colored macules on palms and soles +/- exfoliation.  Non-painful and non-pruritic.
  • DDx to consider: Erythema multiforme, RMSF, meningococcemia, Hand-foot-mouth disease
  • Tx: Penicillin G LA 2.4 million units IM x1 (for primary of secondary)
  • Note: Jarisch Herxheimer Rx- fever, fatigue, myalgias, headache, tachycardia following administration of treatment and destruction of spirochetes.  Self limited and resolves 24-48 hours but can be severe.  Treat with NSAIDs.

Case 4: Osteomyelitis in Adolescent

  • ALWAYS consider osteomyelitis in patient with pain with movement of an extremity, refusal to bear weight or pain to palpation over boney structure (it’s not just rule out septic joint!)
  • Usually patients will have vague systemic symptoms (ex. Fever, fatigue, headache, etc.) so we must keep a high level of suspicion.
  • If there is a concern get testing:  CRP >10 is ~90% sensitive a few days into illness, however, standard of care is MRI (Xrays are frequently completely normal)
  • It is always reasonable to have a patient return to ED in 24 hours for re-evaluation

Case 5: Guttate Psoriasis

  • Generally rare disease process, but most common in children and young adults <30 years old
  • >50% associated with recent or active group A streptococcal infection
  • Heralded by acute eruption of erythematous, patches, +/- some scale.  Often mildly pruritic.  Typically begins over proximal extremities and spreads to trunk.  Guttate means “drop” and rash typically appears as “drops” over the skin surface in appearance.
  • Treatment: Phototherapy and topical steroids.  For recurrent can consider tonsillectomy if secondary to recurrent GAS infections.
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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Medical Students at CMC
    • EM Acting Internship
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction