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This article reviews the literature regarding drug reaction with eosinophilia and systemic symptoms (DRESS) and focuses on the EM and critical care physician’s perspective, summarizing the presentation, clinical features, and management.
Source
Drug reaction with eosinophilia and systemic symptoms: An emergency medicine focused review. Am J Emerg Med. 2022 Jun;56:1-6. doi: 10.1016/j.ajem.2022.03.024. Epub 2022 Mar 18.
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Point-of-care ultrasound (POCUS) was accurate in distinguishing cellulitis from abscess.
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If you accidentally glue someone’s eye shut, soaking the eye in dexamethasone, polymyxin B, neomycin antibiotic drops was most effective at loosening histoacryl tissue adhesive.
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Treating non-purulent cellulitis with narrow spectrum antibiotics improves meaningful patient outcomes. Stop throwing vancomycin around or adding TMP/SMX to cephalexin if there is no pus. See this algorithm.
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Point of care ultrasound was accurate for diagnosis of skin abscess, but the results of this review may have been inflated. It is likely most helpful in uncertain cases.
Simply providing cool running water for 20 minutes within 3 hours of injury for children with burns was associated with a marked reduction in need for skin grafting and possibly burn depth and need for hospitalization.
Point of care ultrasound (POCUS) wasn’t better than physician judgment when they were certain an abscess was present, but it was of some value in equivocal cases, though far from a gold standard.
Propofol may rarely cause greenish discoloration of the hair. It is benign and self-limited.
Treating skin and soft tissue abscesses with antibiotics in addition to incision and drainage (I&D) resulted in significantly increased clinical cure rate (NNT = 14) and decreased incidence of new lesions (NNT = 10) compared to I&D alone.
”Tachypnea at triage, chronic ulcers, history of MRSA colonization or infection, and cellulitis within the past year,” were the risk factors associated with failure of oral antibiotic therapy for non-purulent cellulitis.
