Three days of body rash

Treatment

• Scene – n/a

• En route – position of comfort, monitor

• Hospital – IV, Zofran

Disposition

• Response to treatment – no change

• Disposition – pt transferred to Randall’s without change

Authors:

• Eric Boyd, Paramedic Woodburn Ambulance

Editors:

• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center

Diagnosis

• Rash
• Petechial rash

Differential Diagnosis

• Viral exanthem

• Stevens-Johnson syndrome

• Allergic reaction (urticaria)

• Meningococcemia (less likely with blanching rash)

Patient Workup History

• Patient states – rash has developed over 3 days. He first noticed it at school.

• Pt was seen in ED in the last 2 days and given prednisone without relief.

• Pt complains of n/v today with an onset of fever.

• No Hx of rash

• Recent URI

Physical Exam

• Head to toe non-blanching rash with areas of petechiae on chest, back, and face.

• GCS – 15

• EKG – Sinus tach

• CBG – n/a

Key Points

• Non-specific rashes may accompany upper respiratory infections.

• Viral exanthems can vary in appearance but most commonly present as a non-painful faint erythematous macular or papular rash on the trunk and extremities that blanch.

• Give patients clear instructions regarding return for reevaluation (examples: if rash worsens, becomes purpuric, lasts longer than anticipated, or is accompanied by unexpected fever). Editor’s Notes The patient overall appears alert and in no distress. The rash seems to blanch (see @ 1 minute point into the clip), which is a reassuring finding, in general. This patient’s history is a potential key to diagnosis: He states that he had a viral URI prior to this rash. What does that suggest to you?

-Dr. David Spiro

Suggested Workup

• Most viral exanthems are diagnosed based on clinical appearance and supporting history, without the need for lab testing.

Suggested Treatment

• Supportive care

Suggested References

Characterizing Viral Exanthems

Patient

• Gender: Male

• Age: 17 years

• Height: Not Available

Vitals

• Temperature: 99.8 F/37.7 C

• Blood Pressure: 127/80

• Heart Rate: 120 • Respiratory Rate: 18

• Pulse Oximetry: 100% RA

Signs and Symptoms

Non-pruritic, head-to-toe rash, spread from chest over 3d; fever; recent URI

History Medical

• PMH: Up-to-date on vaccinations

• Allergies: None

• Dispatch info: Transfer to children hospital for rash

Social

• Lives at home with parents; no drug or alcohol use

Medications

• None