SimWars
This post is part of a series developed in preparation for participation in ACEP SimWars. It contains a review of several prominent emergency medicine topics which may be relevant for board preparation. Unless otherwise cited, content is based on HippoEM videos.
- Pediatric Emergencies
- Altitude and Dysbarism
- Bites
- Electrical Injuries
- Heat Emergencies
- Hypothermia
- Radiation Exposure
- Submersion Injury
- Hematologic Emergencies
- Bleeding Disorders
- Oncologic Emergencies
- Adrenal/Pituitary Emergencies
- Thyroid Emergencies
- Acid-Base Disturbances
- Dermatologic Emergencies
- Toxicology
Urticaria/Anaphylaxis
- Appearance: diffuse maculopapular, edematous plaques
- Symptoms: known trigger, transient, pruritic
- Management: remove trigger, epinephrine, glucagon
EM/SJS/TEN
- EM
- Causes: drugs, HSV
- Appearance: target lesions, symmetric, palm/sole involvement
- Management: remove offending agent, supportive care
- SJS (<10% TBSA)
- Cause: drugs
- Appearance: >2 mucous membranes
- Findings: +Nikolsky
- Symptoms: flu-like
- Management: burn center, dermatology consult
- TEN (>30% TBSA)
- Management: IVIG, steroids, burn center, dermatology consult
SSSS
- Epidemiology: <6yo, older if immunosuppressed
- Appearance: painful, diffuse erythema, bullae, no MM involvement
- Stage 1: tender erythroderma
- Stage 2: exfoliation
- Stage 3: desquamation
- Findings: +Nikolsky
- Management: antibiotics (cephalosporin), no steroids
Rash Mnemonics
Palmar Rash
- “sifting rocks scabbed Emma’s palms”
- Syphilis (2°)
- RMSF
- Scabies
- EM
Nikolsky Sign
- SJS/TEN
- SSSS
- PV
Petechiae/purpura
- RMSF
- Meningococcemia
- DIC
- Endocarditis
- TTP/HUS
Meningococcemia
- Epidemiology: <20yo, dorm, military barracks
- Appearance: diffuse petechiae, palpable purpura
- Management: antibiotics, steroids
Necrotizing fasciitis
- Symptoms: POOP, rapid progression
- Appearance: bullae, crepitus, systemic toxicity
- Management: surgery, antibiotics
RMSF
- Symptoms: flu-like
- History: tick bite, camping/hiking
- Appearance: wrist/ankle spreading inward (centrifugal), petechiae
- Diagnosis: clinical, titers
- Management: doxycycline (increased mortality if not treated)
PV
- Epidemiology: 40-60yo
- Pathophysiology: autoantibodies (desmoglein), causes superficial epidermal separation (pemphigus for superficial)
- Symptoms: painful oral blisters, small bullae
- Findings: +Nikolsky
- Management: steroids (methylprednisolone 1g IV), burn center
BP
- Epidemiology: >70yo
- Pathophysiology: autoantibodies, deeper dermal layer (pemphigoid for deep)
- Symptoms: not painful, no oral lesions
- Findings: large, tense, unruptured bullae
- Management: steroids