Dermatologic emergencies

Being able to recognize and treat a dermatologic emergency is extremely important to the primary care physician. This ability is very rewarding for the patient and gratifying to the physician. In this article, some of the more commonly encountered emergencies are discussed.     

Dermatologic emergencies

Primary care physicians are the gatekeepers of the medical community. They are the physicians to whom patients first present, and they are often the physicians with whom patients have the longest lasting relationships. Primary care physicians, as a result of these long-term relationships, have been endowed with a unique responsibility to the health of their patients. By the very nature of their practice, primary care physicians do not have the resources to treat emergent life-threatening conditions. They must, however, be able to diagnose these potentially life-threatening conditions and be able to stabilize and appropriately refer a patient for urgent evaluation by specialists or emergency physicians. There are many types of emergencies encountered in the outpatient setting, ranging from cardiac to toxicologic. As important as recognizing signs and symptoms of cardiac ischemia is the ability to recognize potentially life-threatening dermatologic disorders or dermatologic manifestations of life-threatening systemic diseases.     

Dermatologic formulary

The formulary for dermatologic use in the emergency department must not only encompass drugs that are essential for advanced cardiac and trauma life support, but must have specific drugs that are indicated for common dermatologic conditions that are evaluated in the emergency department. First and foremost is the selection of the appropriate drug for the disease. Other factors, such as the vehicle in which the drug is compounded, become equally important, as this directly affects the delivery of medication to the patient. Although this formulary is by no means complete, it is a reasonable guide for emergency medicine physicians to utilize when comtemplating dermatologic care. It is important when selecting a drug for dermatologic care that the physician be cognizant of the patient--the type, location, and condition of the skin--and of the disease he or she is treating. When these factors are given due consideration, the appropriate drug for the disease will be utilized for the ultimate benefit of the patient.     

Sonography of Dermatologic Emergencies

Dermatologic conditions may be the subjects of potential emergency consultations, and the knowledge of their sonographic appearance can facilitate an early diagnosis and management. In this pictorial essay, the sonographic dermatologic anatomy, technique, and conditions that can be supported by a prompt sonographic diagnosis are reviewed. The sonographic signs that may help diagnose these entities are discussed with a practical approach.     

Readysource Seclected Dermatologic Problems

ReadySource is intended for the reader who wishes more information on or education in the particular subject area. It is drawn from several sources: the Educational Resource Index, a computerized listing developed by the Department of Continuing Education, University of Wisconsin-Extension; announcements by individual medical schools and teaching hospitals; information provided by the author; and our own files. Listing does not necessarily imply endorsement by the university, POSTGRADUATE MEDICINE, or the author of the article. Readers interested in a meeting or audiovisual aid should write directly to the contact listed.     

Dermatologic manifestations of HIV infection

Nearly all patients infected with the human immunodeficiency virus (HIV) will develop cutaneous or mucous membrane manifestations. Oral cavity lesions associated with HIV disease include candidiasis, hairy leukoplakia and Kaposi's sarcoma. Skin infections such as herpes simplex, herpes zoster, molluscum contagiosum, Staphylococcus aureus folliculitis and warts are often more severe than usual and may be refractory to therapy. Seborrheic dermatitis is the most common cutaneous eruption. The appearance of Kaposi's sarcoma in a patient younger than 60 years of age or in any individual with laboratory evidence of HIV infection is diagnostic of acquired immunodeficiency syndrome. Serious drug reactions may occur, despite the depressed cellular immunity associated with HIV infection.     

Dermatologic complications in HIV.

The skin is unique in its accessibility for the diagnosis of diseases acquired because of decreased immunity in human immunodeficiency virus (HIV) infection. A majority of HIV-infected patients will have dermatologic problems at some time during their illness. Many of the cutaneous conditions identified will provide the means by which systemic opportunistic infections, neoplasms, and complications of therapy can be identified. The skin provides an opportunity for the recognition of new or foreign conditions as well as exotic manifestations of diseases that complicate HIV infection. A high degree of suspicion and a willingness to examine the entire skin thoroughly and frequently can enable practitioners to reduce the morbidity and mortality associated with HIV infection.     

Genitourinary emergencies

An awareness of pitfalls and perils in diagnosis of traumatic injuries to the genitourinary tract, and indications and contraindications for studies and instrumentation, will help diagnose these sometimes underdiagnosed injuries and help minimize morbidity. Suspicion of testicular torsion should lead to prompt urologic consultation, and priapism also should be promptly treated to preserve function. The treatment of acute urinary retention consists of prompt bladder drainage with attention to etiology and methods.     

Respiratory emergencies

This article is intended as an overview of emergencies that could and often do present to the physician's office, especially when a hospital emergency department may not be nearby. It is not intended as an in-depth view of every problem but should be considered as a presentation of essential management in the emergency phase of treatment. The reader is directed to the references for more in-depth information on these topics.     

Aortic emergencies

Aortic emergencies present a diagnostic and treatment challenge for emergency physicians. Both acute aortic dissection and abdominal aortic aneurysms can be difficult to recognize, and a missed or delayed diagnosis may be fatal. A high clinical suspicion and rapid patient evaluation are important. Although many patients ultimately require surgical intervention, early and aggressive attention to hemodynamic stability by the emergency physician can provide a window to definitive treatment.