Nov 272010
 
Allergic purpura, or anaphylactoid purpura, is a type of nonthrombocytopenic purpura. It’s characterized by allergy symptoms and acute or chronic vascular inflammation affecting the skin, joints, or GI or genitourinary (GU) tract. When allergic purpura primarily affects the GI tract with accompanying joint pain, it’s called Henoch-Schönlein syndrome or anaphylactoid purpura. However, the term allergic purpura applies to purpura associated with many other conditions, such as erythema nodosum. An acute attack of allergic purpura can last for several weeks and is potentially fatal (usually from renal failure); however, most patients do recover.
Fully developed allergic purpura is persistent and debilitating, possibly leading to chronic glomerulonephritis (especially following a streptococcal infection). Allergic purpura affects more males than females and is most prevalent in children ages 3 to 7. The prognosis is more favorable for children than for adults.
Causes
The most common identifiable cause of allergic purpura is probably an autoimmune reaction directed against vascular walls, triggered by a bacterial infection (particularly streptococcal infection). Typically, an upper respiratory tract infection occurs 1 to 3 weeks before the onset of symptoms. Other possible causes include allergic reactions to some drugs and vaccines, allergic reactions to insect bites, and allergic reactions to some foods (such as wheat, eggs, milk, and chocolate).
Signs and symptoms
Allergic purpura is characterized by purple skin lesions that are macular, ecchymotic, and varying Continue reading »
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Nov 242010
 
Poisonous snakebites are most common during summer afternoons in grassy or rocky habitats. Poisonous snakebites are medical emergencies. With prompt, correct treatment, they need not be fatal.
Causes
The only poisonous snakes in the United States are pit vipers (Crotalidae) and coral snakes (Elapidae). Pit vipers include rattlesnakes, water moccasins (cottonmouths), and copperheads. They have a pitted depression between their eyes and nostrils and two fangs, ¾? to 1¼? (2 to 3 cm) long. Because fangs may break off or grow behind old ones, some snakes may have one, three, or four fangs.
Because coral snakes are nocturnal and placid, their bites are less common than pit viper bites; pit vipers are also nocturnal but are more active. The fangs of coral snakes are short but have teeth behind them. Coral snakes have distinctive red, black, and yellow bands (yellow bands always border red ones), tend to bite with a chewing motion, and may leave multiple fang marks, small lacerations, and much tissue destruction.
Signs and symptoms
Most snakebites happen on the arms and legs, below the elbow or knee. Bites to the head or trunk are most dangerous, but any bite into a blood vessel is dangerous, regardless of location.
Most pit viper bites that result in envenomation cause immediate and progressively severe pain and edema (the entire extremity may swell within a few hours), local elevation in skin temperature, fever, skin discoloration, petechiae, ecchymoses, blebs, blisters, bloody wound discharge, and local necrosis.
Because pit viper venom is neurotoxic, pit viper bites may cause local and facial numbness and Continue reading »
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Nov 212010
 
  • Establish and maintain a patent airway; nasal airways are contraindicated in patients with possible basilar skull fractures. Intubation may be necessary.
  • Suction the patient through the mouth, not the nose, to prevent the introduction of bacteria in case a CSF leak is present.
  • Be sure to obtain a complete history of the trauma from the patient, his family, any eyewitnesses, and ambulance personnel.
  • Ask whether the patient lost consciousness and, if so, for how long. The patient will need further diagnostic tests, including a complete neurologic examination, a CT scan, and other studies.
  • Check for abnormal reflexes such as Babinski’s reflex.
  • Look for CSF draining from the patient’s ears, nose, or mouth. Check bed linens for CSF leaks, and look for a halo sign. If the patient’s nose is draining CSF, wipe it—don’t let him blow it. If an ear is draining, cover it lightly with sterile gauze—don’t pack it.
  • Position the patient with a head injury so secretions can drain properly. Elevate the head of the bed 30 degrees if intracerebral injury is suspected.
  • Cover scalp wounds carefully with a sterile dressing; control any bleeding as necessary.
  • Take seizure precautions, but don’t restrain the patient. Agitated behavior may stem from hypoxia or increased ICP, so check for these symptoms. Speak in a calm, reassuring voice, and touch the patient gently. Don’t make any sudden, unexpected moves.
When a skull fracture requires surgery:
  • Obtain consent, as needed, to shave the patient’s head. Explain that you’re performing this Continue reading »
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