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Terms in this set (63)

A superficial partial-thickness injury: considered minor if covers < 5% of total body surface area (BSA) in pts <10 or>50, or < 10% in pts between 10 and 50 y/o. Not be considered minor if its circumferential or affects the face, hands, feet, genitals, perineum, or major joints (In such cases, consult and possible transfer to burn center).
if blisters intact, they should not be intentionally ruptured and needle aspiration should not be performed, bc increases risk for infection. Gentle cleansing and dressing of affected area w/ a moisturizing cream followed by a non-adherent bandage sufficient. Minor burns are painful & tx w/ oral analgesics. Acetaminophen or NSAID alone or in combo w/ opioids.

Debridement of blisters and dressing of affected area with topical antibiotic is appropriate for deep partial-thickness burns where the blisters are unroofing, and necrotic and sloughing tissue is adhering to the surface of the skin. This tissue should be removed as it can prevent contact of antibacterial agents with the wound or may introduce bacteria.. This can be a very painful procedure, so sufficient analgesia should be considered, including IV opioids or sedation.

Consider escharotomy for circumferential and full-thickness burns

Children w/ partial-thickness burns should be seen for f/u the day after injury to adjust pain management, as needed, and reassess care of burn. Afterward, pt can be seen weekly until epithelialization occurs unless complications such as infection develop. Healing usually requires seven to 21 days.
1: measles/rubeola- sx don't appear for 10-14 days after exposure.... Severe, brassy cough; coryza; conjunctivitis; sore throat, fever (appears 3-4 days before exanthem), and a red, blotchy skin rash (begins on face and spreads to trunk/extremities).
-Koplik's spots (blue-white spots with a red halo) on buccal mucous membrane opposite premolar teeth 24-48 hrs before exanthem rash begins

2: scarlet fever/scarlatina- caused by strep pyrogens.
rash of very small red bumps that begin on neck and groin and spreads to rest of body, characteristic feel of sandpaper and lasts 5-6 days. Once rash fades, skin may peel(for up to 6 weeks). Theres usually a pale area around mouth (circumoral pallor). Another finding is dark, hyperpigmented areas esp in creases called Pastia's lines/sign.
-rash, fever, sore throat, white strawberry tongue (By day 4 or 5, white membrane sloughs off, revealing a shiny red tongue w/ swollen papillae (red strawberry tongue).
Tx: PCN G or VK

3: Rubella, German Measles, 3-day measles- rash begins as discrete macules on face that spread to neck, trunk, and extremities. The exanthem lasts 1-3 days. On occasion a nonspecific enanthem (Forscheimer's spots) of pinpoint red macules and petechiae on soft palate and uvula just before or w/ the exanthem. The hallmark is the generalized tender lymphadenopathy involves all nodes, but most striking in the suboccipital, postauricular, and anterior and posterior cervical nodes.

4: Filatow-Dukes' Disease, Staphylococcal Scalded Skin Syndrome, Ritter's disease: SSSS usually see in infants and begins w/ abrupt perioral erythema, well-demarcate and tender to the touch. Covers most of the body in ~2 days. positive Nikolsky's sign. In most cases lesions become fluid filled bullae or blisters. (clear and does not contain bacteria or WBCs). The lesions do not always fill with fluid and in this case some refer to the disease as staphylococcal scarlet fever.

5: Erythema infectiosum- caused by Erythrovirus (Parvovirus) B19. Pruritus, low-grade fever, malaise, and sore throat precede the rash in ~10% of cases. Lymphadenopathy is absent. There are 3 distinct, overlapping rash stages. Facial erythema ("slapped cheek") -- red papules on cheeks that rapidly coalesce in hours, forming red, slightly edematous, warm, plaques that are symmetric on both cheeks but dont cover nasolabial fold and circumoral region. Fades in 4 days. Net pattern erythema is in a fishnetlike pattern--begins on extremities ~2 days after onset of facial erythema and extends to trunk and buttocks, fading in 6-14 days. The eruptions may fade and then reappear in previously affected sites on face and body during the next 2-3 weeks (recurrent phase). Temp changes, emotional upsets, and sunlight may stimulate recurrences. Rash fades w/o scaling or pigmentation
•fiery-red facial erythema -> lacy, reticular

6: Exanthem subitum, Roseola infantum, "Sudden Rash", rose rash of infants, 3-day fever- Caused by HHVB6 or HHV7 a sudden onset of high fever of 103-106° F w/ few or minor sx. Most appear inappropriately well but may experience slight anorexia or 1-2 episodes of vomiting, running nose, cough, and hepatomegaly. The rash begins as the fever goes away. The term exanthem subitum describes the sudden "surprise" appearance of rash after fall of the fever. Numerous pale pink, almond-shaped macules appear on trunk and neck. They become confluent, and then fade in a few hours to 2 days w/o scaling or pigmentation.
point mutation where valine substituted for glutamic acid on beta chain --> HbS which has decreased solubility under hypoxic conditions, leading to vast-occlusion and hypoxia. Sickled cells are destroyed by the spleen --> hemolytic anemia

sickle cell trait (AS): usually asymptomatic and not anemic unless exposed to severe hypoxia, may develop episodic hematuria or isosthenuria
dx: hemoglobin electrophoresis- presence of both hemoglobin A (HbA) and HbS with greater amount of HbA
tx: usually none required

SCD: sx begin as early as 6 m/o, dactylitis is the MC initial presentation
-infections- functional aslepnia leads to ^ risk of infections. Salmonella osteomyelitis, aplastic crisis associated w/ parvovirus b19 infections
-painful vaso-occlusive crisis: acute abrupt pain, priapism common, avascular necrosis of bone
-skin ulcers (esp tibia),
-chronic hypoxia: palm HTN, CHF, sx of fatigue
-stroke: 25% have one by age 45

dx: peripheral smear best initial test- target cells, sickles erythrocytes, decreased H&H, Howell-jolly bodies (indicated functional asplenia)
-hemoglobin electrophoresis: HbS (little to no HbA), increased HbF

tx: Pain control: IV hydration and oxygen first step in management of pain crisis, RBC transfusion therapy for severe crisis
- hydroxyurea: (increased production of HbF & reduced RBC sickling) reduces frequency and severity of pain episodes, prolongs survival

in children prophylactic PCN given as early as 2-3 months until at least 5 y/o ro prevent infectious complications