The Case:
An otherwise healthy 3-year-old presented to the emergency department with a chief complaint of a pruritic rash for 2 days that started on the back and progressed down the arm to the hand. The child and his family were migrants recently arriving in the United States from South America and currently staying at a migrant shelter. The patient’s blood pressure was 104/60 mmHg, heart rate 100 BPM, respiratory rate 22 BPM, oxygen saturation 97% on room air, and temperature 37ºC (98.6ºF). On examination, the child was overall well-appearing, and significant only for a crusted-over patch of lesions was noted at the C6-7 dermatome on the child’s back lateral to midline, clustered papulovesicular lesions along the outer side of the left arm and involving the left hand along the C6-7 dermatome. What is causing the patient’s rash?
Michael Hohl, MD and Alisa McQueen, MD
Read MoreThe literature on antibiotic prophylaxis for traumatic wounds is usually poor and tends to be left to EM physician gestalt or subspecialty preference. In the case of someone without access to subspecialist consultation in a young, healthy patient, understanding the literature may help us decrease our antibiotic prescribing and become better antibiotic stewards. Here, we review some common clinical conditions in which the ED physician may feel comfortable giving or not giving antibiotics using an evidence-based approach.
Jose Reyes, MD
Read MoreA 37-year-old man with no past medical history presented after he was bit by a bat on the index finger of the right hand. He stated he reached into a box to remove what he thought was a rag. In fact, it was a bat that had its wing trapped by a paint can (Figure 1). He was concerned about rabies and presented to the ED for further care.
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