The ED Approach to Pediatric Rash · 2019-02-01 · Approach to Pediatric Rashes Step 1: Sick or...
Transcript of The ED Approach to Pediatric Rash · 2019-02-01 · Approach to Pediatric Rashes Step 1: Sick or...
The ED Approach to Pediatric Rash
Ashley Strobel MD, FACEP
Assistant Professor of Emergency Medicine
Hennepin County Emergency Department Faculty
University of Minnesota Masonic Children’s Hospital Division of Emergency Medicine
Adjunct Faculty
Objectives
• Describe a simple approach to pediatric rashes
• Highlight life-threatening, can’t miss rashes
• Discuss management of some common rashes
NO DISCLOSURES
What’s this rash?
Rashes are ubiquitous!
Red Flags to
Slow Down
your Thinking
Historical Clues for
Pediatric Rash
Exam Red
Flags for
Pediatric
Rash
Approach to Pediatric Rashes
Step 1: Sick or not sick?
Step 2: Exam Red Flags• Mucous membrane?
• Palms and soles?
• Nikolsky?
• Petechiae or purpura?
Step 3: Named pediatric rash?
Step 4: Neonate?
Step 5: Pruritic?
Step 6: Admit you aren’t sure! Offer a referral
to Dermatology.
Even Dermatology doesn’t have all the answers!
EXCEPTIONS: Mucous Membrane Involvement
Benign Newborn Rashes…
Can’t Miss Rashes:
Kawasaki
Pruritis?
Stop the Itch:
Cetirizine, Ranitidine,
Diphenhydramine
Anti-Inflammatory:
Tacrolimus, Pimecrolimus
Steroids (ointments > creams)
Skin Barrier Emollients: Aveeno, Eucerin, Vanicream, Vaseline, Aquaphor, Cetaphil
2018 EBM Atopic Dermatitis Therapy:
RASH
NOT SICKTOXIC
Labs
ED Derm
Consult vs
Admission
IV Antibiotics
o SJS/TEN/MERM
o Syphilis
o RMSF
o Meningococcemia
o ITP
o HUS
o Leukemia
o Disseminated
HSV
o TSS
o Necrotizing
Fasciitis
o Kawasaki
Pruritis?
Steroids & Anti-
histamine
Mucous
Membrane
Petechiae/
Purpura
Palms and
Soles
Nikolsky
NeonateIt’s viral
Supportive cares
Yes, this includes
Gianotti CrostiPain out of
proportion
Summary: Rash Algorithm
Gianotti Crosti: Papular Acrodermatitis
Questions?
Common Pediatric Rashes
Change the diaper more often
Let the skin breathe
Apply barrier ointment
Apply Nystatin ointment or powder for Candida
Apply Zinc Oxide
Can’t Miss Rashes: Eczema Herpeticum