♛VVIP Hyderabad Call Girls Chintalkunta🖕7001035870🖕Riya Kappor Top Call Girl ...
What's Rash is that!
1. What Rash is that?
Is it Infectious?
By Kane Guthrie
2. Learning Points
• General assessment of rashes
• Describing rashes
• When to Isolate
• Pearls & Pitfalls
• Case studies
3. Rashes
• Most are not evidence of serious illness
• Frequently alarm patients/parents
• Rashes are one of the top 20 presentations to ED
• Often anxiety provoking to health care providers
9. History Taking
• When did it start?
• How quickly did it progress?
Pearl:
• The more lethal – the more rapid progression!
10. History Taking
• Has the rash changed over time?
• Where did it start & progress to?
• Is the lesion pruritic?
– Allergic response!
11. History Taking
• Recent travel?
– In the last month!
• PMHx:
– Immunocompromised, asplenia, cancer, DM, ETOH
• Occupation
– Child care, student, military, aid workers
• Medications
12. Physical Exam
• Get them undressed!
Check:
• Oral cavity
• Adenopathy
• Hepatosplenomegaly
• Genitals
• Nails & fingers
13. Skin Exam
• Characterise type of lesion
• Shape of individual lesion
• Arrangement of multiple lesions
– Linear, annular, disseminated
• Pattern of rash
– Sun exposed areas, flexor/extensor surfaces
14. Case 1
• 10 year old girl
• Coryza, conjunctivitis, cough, fever
• Maculopapular rash, starts behind ears
• Descends onto upper torso
23. Case 2
• 4 year male
• C/O headache, fever, then rash develops
• Explosion of lesions: 1st to face/scalp, then
trunk & limbs
• No rash soles or palms!
24. The Rash
• Many papules
• Become vesicles
http://bit.ly/1zL2y5E
25. Chicken Pox
• Acute generalised viral infection
• Incubation period 11-17 days
• Highly contagious
• Transmission direct contact/airborne
– Use airborne precautions
26. Shingles
• Blistering rash – dermatome distribution
• Increased age
• Immunosupression
• Stress
http://1.usa.gov/1yBhN0c
29. Case 3
• 17 female
• S/B GP c/o fever, headaches & muscle pain
– Dx: viral illness – sent home to rest
• 12 hours later develops peticial > purpuric
rash
• Arrives in ED shocked!
33. Meningococcal Septicaemia
• Acute Bacterial Infection
• Mainly affects young children/adolescents
• Transmission by direct contact Resp secretions
– Droplet precautions
– AB’s for staff if exposed to resp secretions
• Incubation period 2-4 days
38. Hand Foot & Mouth Disease
• Coxsackie virus
• Common in kids- can affect all age groups
• Low grade fever, anorexia, sore mouth
• Oral lesions develop
– Vesicles/erythematous base – painful
• Hand/foot lesions – red papules
• Symptomatic care- mouth wash/analgesia
39. Case 6
• 28 male
• Hx epilepsy, on phenytoin
• Presents: Shocked
• Severe mouth ulcers
• Maculopapular rash
53. Scabies
• Skin infestation scabie mite
• 4-6 wk incubation period
• Not a reflection of poor hygiene!
• General eruption: linear burrows, papules,
pustules
• Treatment: Permethrin 5% all family members
http://www.wikem.org/wiki/File:ScabiesD08.JPG
61. Take Home Points
• Pattern recognition is everything
• Always take a good history
• Isolate if unsure
• Look for:
– Fever, toxicity, distribution, specific signs
• Management is generally simple