Dr. Graham- Necrotizing soft tissue infections

• Symptoms- erythema, swelling, crepitus, fevers, pain out of proportion to exam, hypotension, hemorrhagic bullae
• Labs- leukocytosis, elevated inflammatory markers, elevated creatinine, hyperglycemia, hyponatremia
• Imaging- CT with gas in subcutaneous tissue, fat stranding
• Treatment- fluid resuscitation, triple antibiotics (broad spectrum- meropenem or zosyn, MRSA- vancomycin, antitoxin- clindamycin), surgical consult

Dr. Stewart- SJS/TEN

• SJS- less than 10% total body surface area
• Overlap SJS/TEN- between 10 and 30% total body surface area
• TEN- greater than 30% total body surface area
• Causative medications- allopurinol, anticonvulsants, sulfa drugs, antibiotics
• Labs- CBC, CMP, inflammatory markers
• SCORTEN- severity of illness score for TEN
• Management- fluid replacement, temperature control, +/- steroids
• Dispo- trauma/derm/burn unit

Dr. Firquin- Pediatric respiratory emergencies

• Croup- URI symptoms, fevers, stridor, barking cough, symptoms worse at night, hypoxia is uncommon
  • Corticosteroids (0.6mg/kg with max 16mg), racemic epinephrine
• Bronchiolitis- URI symptoms, tachypnea, peak at <12months, retractions, poor PO
  • HFNC, suction
• Foreign body aspiration- cough, stridor, tachypnea, sudden episodes
  • XR, bronchoscopy
• Asthma- wheezing, cough, triggered by viral illness
  • Albuterol, ipratropium, steroids
  • Magnesium- side effects of bradycardia and hypotension
  • Epinephrine IM 0.1mg/kg for severe cases
  • Terbutaline for severe cases
  • Consider CXR on first time wheezer

Dr. Smith- Cutaneous ulcers

• Diabetic foot wound- neuropathic ulcer over bony prominences of foot, cover for MRSA and pseudomonas for infection, non-infected wounds can be discharged with outpatient follow-up
• Venous stasis ulcer- caused by poor venous return, shallow ulcers with irregular borders, wet to dry dressings, elevation of leg, compression stockings, oral antihistamines for itching
• Pressure ulcer
  • Stage 1/2- dressing changes, padding for pressure relief
  • Stage 3/4- debridement, wound care, ongoing pressure relief
• Arterial insufficiency ulcer- usually able to be managed as outpatient as long as patient has good capillary refill, pulse
  • Pulseless- CTA, trauma consult
• Calciphylaxis- ESRD patients, deposition into arteries, rapidly progressive lesions
  • treatment with calcium control and possible surgical intervention