Environment and Toxicology Emergencies Flashcards
Recommend management for fungal infections: tinea cruris and tinea pedis.
Tinea cruris (jock itch) is a fungal infection of the perineal area, penis, inner thighs, and inguinal creases, but may also occur under breasts in women and beneath abdominal folds where skin is warm and moist. It rarely occurs before adolescence.
Symptoms include:
-Scaly, itching, erythematous rash that may contain papules or vesicle and is usually bilateral and symmetrical.
Treatment:
- Selenium sulfide shampoo wash of area before applying medication.
- Topical antifungal (clotrimazole, miconazole, tolnaftate, naftifine, terbinafine) 2 times daily for 4 weeks.
Tinea pedis (athlete’s foot) is a fungal infection of the feet and toes. It is rare before adolescence and is more comm in males.
Symptoms include:
- Severe itching with vesicles or erosion of instep and with peeling maceration and fissures between toes.
- Dry, scaly, mildly erythematous patches on plantar and lateral foot surfaces.
Treatment:
-Same as tinea cruris.
-Keep feet dry with absorbent talc.
Allow feet to air dry and use 100% cotton socks, changed twice daily.
Discuss the management of pediculosis (lice).
Pediculosis is infestation with lice, transmitted by direct contact with someone who is infested.
- Head lice is most common in children.
- Body lice is most common in transient populations. They feed on the body but live in clothing or bedding and are spread by sharing bedding, clothes, or towels.
- Pubic lice spread by sexual contact or (rare) sharing clothes or bedding, and may infest the genital area, eyebrows, eyelids, lower abdomen, and beard.
Symptoms include:
-Persistant itch (usually worse at night), irritation, excoriation, and sometimes secondary infection.
Diagnosis:
-Clinical exam and finding of lice or nits.
Treatment includes:
- Permethrin 1% cream rinse applied after body or hair is shampooed with a non conditioning shampoo and then towel dried. (Treatment of choice) It is left on for 10 minutes and then rinsed off, leaving residue designed to kill nymphs emerging from eggs not killed with the first application. Treatment is often repeated in 7 to 10 days.
- Nits should be manually removed.
Explain the pathogenesis and symptoms of scabies.
Scabies is caused by a microscopic mite, Sarcoptes scabiei hominis, which tunnels under the outer layer of skin, raising small lines a few millimeters long. Mites prefer warm areas, such as between the fingers and in skin folds, but can infest any area of the body. As the mites burrow, they cause intense itching and subsequent scratching can result in excoriation and secondary infections. Some develop a generalized red rash.
Scabies is spread very easily through person-to-person contact and has become a problem in nursing homes and extended-care facilities where staff spread the infection. Incubation time is 6 to 8 weeks and itching usually begins in about 30 days, so people may be unaware they are transmitting scabies.
Most infestations involve only about a dozen mites, but a severe form of scabies infection, Norwegian or crusted scabies, can occur in elderly patients or those who are immunocompromised, and usually causes less itching. However, lesions can contain thousands of mites, making this type highly contagious.
Discuss the diagnosis and treatment of scabies.
Diagnosed through skin scrapings, but because so few adult females usually infest a person, a negative finding does not mean that the person does not have scabies. When examining a patient with suspected scabies, it is helpful when searching for burrows to use a magnifying glass and a small flashlight held at an oblique angle.
Treatment includes:
- Scabicide: permethrin 5% cream applied from chin to toes and left on for 12 hours and then showered off with a repeat treatment in 1 week (drug of choice) / sulfur in petrolatum 10% concentration applied to entire body below the head on 3 successive nights and the bathe 24 hours after each application (safe for small children and pregnant women)
- Oral medication: ivermectin in 2 doses, 1 week apart, which is especially effect for crusted form
- Antihistamines (for itching)
- Antibiotics (if indicated for secondary infections)
Recommend management for tissue damage related to chemical trauma.
Chemical trauma may be caused be leakage or incontinence of body fluids, such as urine, feces, and exudate, or chemicals applied to the skin, such as lotions, iodine, soap, organic solvents, acids, and adhesives.
Reactions to irritant contact dermatitis may vary widely from an itching rash similar to allergic contact dermatitis, to cracks and fissures in the skin, especially on the hands, or denouement of skin, often in the perineal area. The skin reaction may be rapid and extremely painful.
Treatment includes:
- Identifying irritant and eliminating contact with skin.
- Gentle cleansing of skin to remove irritant but avoid further skin irritation.
- Use of skin sealants or skin barriers as indicated to protect the skin and allow healing.
- Use of appropriate skin care products and containment devices.
- Monitoring of dressings and periwound condition daily.
Discuss intestinal parasites: Necator americanus (hookworms).
Necator americanus is the most common species of hookworm found in the southeastern United States. Hookworm larvae may be swallowed directly or penetrate the skin, often the feet of children going barefoot, and migrate to the lungs, where they are coughed up and swallowed, and then carrier to the small intestines, where they attach themselves to the walls to suck blood and multiply.
Severe infection can result in hypochromic, microcytic anemia along with hypoproteinemia and malnutrition. Infection with hookworms can result in dyspnea, cardiomegaly, and arrhythmias, and can be fatal in infants. Infected children may have retarded growth and mental development, which may be irreversible.
Diagnose with serial stool specimens.
Symptoms include:
-Itching and rash at the site of infection, followed by abdominal pain, diarrhea, anorexia, weight loss, and anemia.
Treatment includes: -Albendazole 400 mg once OR -Mebendazole 100 mg daily for 3 days -Iron supplements may be necessary. -Recheck serial stools 1 week after treatment to determine if repeat treatment is necessary.
Recommend management for tissue damage related to allergic contact dermatitis.
Contact dermatitis is a localized response to contact with an allergen, results in a rash that may blister and itch. Common allergens include poison oak, poison ivy, latex, benzocaine, nickel, and preservatives, but there is a wide range of items, preparations, and products to which people may react.
Treatments include:
- Identifying the causative agent through evaluating the area of the body affected, careful history, or skin patch testing to determine allergic responses.
- Corticosteroids to control inflammation and itching.
- Soothing oatmeal baths.
- Pramoxine lotion to relieve itching.
- Antihistamines to reduce allergic response.
- Lesions should be gently cleansed and observed for signs of secondary infection.
- Antibiotics are used only for secondary infections as indicated.
- Rash is usually left open to dry.
- Avoidance of allergen will prevent recurrence.
Discuss the symptoms, diagnosis, and treatment of tapeworm.
Cestodes, or tapeworms, are parasitic worms that live in the intestinal tracts of some animals/fish. There are several different species that can infect humans who eat raw or undercooked meat or fish that contains the immature form of the tapeworm. The worms mature and lay eggs that usually undergo maturation in the small bowel (autoinfection) or pass through the host feces. Many infections are asymptomatic, but heavy infections can cause nausea, vomiting, weight loss, diarrhea, and epigastric and abdominal pain. Pork tapeworms may invade the subcutaneous tissue and CNS, causing epilepsy and neurological compromise. Fish tapeworms may cause pernicious anemia.
Diagnosed by presence of ova and parasites in stool.
Treatment includes:
-Praziquantel 5 to 10 mg/kg one time (drug of choice for all types)
OR
-Nitazoxanide 500 mg for 3 days (dwarf tapeworm)
-Children 1 to 3 years: 100 mg twice daily for 3 days
-Children 4 to 11 years: 200 mg twice daily for 3 days
OR
-Niclosamide 1 g once (beef, pork, fish, and double-pored dog tapeworm)
-Pediatrics: 50 mg/kg single dose
Recommend management of bacterial infection: Staphylococcal scalded skin syndrome (SSSS).
SSSS is a superficial partial-thickness infection of the skin caused by toxins produced by a localized Staph. aureus infection, resulting in generalized erythema followed in 24 to 48 hours with blisters that reputed and peel off, leaving large areas of superficial necrosis and denuded skin, giving the skin a burned or “scalded” appearance.
It is most common in neonates and children younger than 5, and can be confused with noninfectious diaper rash or candidiasis. It can affect adults who are immunocompromised or in renal failure. Pain is usually mild unless the infection is very widespread.
Treatment includes:
- IV antibiotics (such as flucloxacillin) are usually needed initially, followed by a course of oral antibiotics.
- Maintenance of fluids and electrolytes.
- Debridement of skin.
- Moisture-retentive dressings, such as foam dressings, sheet hydrogels, and alginates; avoid adhesives.
- Excessive tissue loss may be treated the same as partial-thickness burns.
Discuss intestinal parasites: roundworms.
There are numerous helminths (worms) that can cause intestinal infections. Studies estimate that 50 million children in the United States are infected with worms.
Risk factors include:
- Young age
- Going barefoot
- Poor sanitation of food and water
- Poor hygiene
- Living in or traveling to an endemic area
- Immigrant status, especially from Mexico
Roundworms (Ascaris lumbricoides) can grow 6 to 13 inches in length, and a child may have up to 100 worms. After ingestion of eggs from contaminated raw foods or vegetables, the worms migrate to the intestines but can migrate to other organs, such as the lungs, and cause serious damage. They may also multiply in clumps and cause intestinal obstruction or may penetrate the intestinal wall causing peritonitis.
Symptoms include:
- Malnutrition
- Abdominal discomfort
- Passing worms in stool or emesis
Treatment includes: -Albendazole 400 mg PO once OR -Mebendazole 100 mg daily for 3 days OR -Pyrantel pamoate 11 mg/kg once -Piperazine citrate 75 mg/kg/day for 2 days for intestinal obstruction
Recommend management for fungal diaper rash: candidiasis.
Candidiasis, infection of the epidermis with Candida spp. (commonly referred to as “yeast” or “thrush”), causes a pustular erythematous papular rash that is commonly scaly, crusty, and macerated with a white, cheese-like exudate. It may burn and is usually extremely pruritic and grows in warm, moist areas of the skin, such as the perineal area, and is aggravated by the use of disposable diapers. Candidiasis must be differentiated from bacterial infections because antibiotic treatment will worsen the condition.
Treatment includes:
- Preventing humid, moist conditions of skin.
- Controlling hyperglycemia.
- Careful cleansing and exposing area to air as much as possible.
- Topical antifungal creams (nystatin) with each diaper change or 4 times daily.
- Zinc chloride ointment over antifungal to provide barrier protection.
- Topical antifungal powders for mild cases.
- Oral antifungal (fluconazole) for severe cases.
