so much itching

8/2/2019 So Much Itching

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So Much Itching

Morning Report 4/9/12

Adam Ware



4 year old with rash

• CC: Rash

• History of Present Illnes:

– 2 weeks ago had 10 days of cough, congestion, rhinorrhea.

–

Received vaccinations 6 days ago• MMR, DTAP, IPV, Varicella

• Local reaction with erythema, swelling, “pus” that lasted 2 days.

– 3 days ago mother noticed pruritis of buttocks.

– Next morning he was covered in “red bumps.”

– Severe itching of bumps even while sleeping.

– 3 episodes of loose stools today.

– Calamine lotion over past day not helping.




• Review of Systems:

– Positive: Subjective fever, pruritic rash, loose stool

– Negative: HA, congestion, rhinorrhea, cough, sore

throat, vomiting,• Past Medical History:

– 34 week gestation hospitalized x 1 wk forrespiratory distress, ROS.

– No recent hospitalization

– No surgeries




• Family History:

– Multiple family members with URI sx 2 weeks ago.

– Brother, Mother, Grandmother all in ED today with

similar rash.

• Social History:

– Lives with father, mother, 10 year old brother.

Have stayed at grandmother’s house for last 4days. + smokers, 2 dogs, 1 cat, no travel.




• Vital Signs: – T: 36.8, P: 92, BP: 94/66, SPO2: 97%, Weight 19.3 kg

(88%)

• Physical Exam: – General: Running in room

– HEENT: NC/AT, PERRRLA, No cong/rhin, MMM, No orallesions, No LAD,

– Skin: clusters of erythematous, blanching, macules

with vesicular appearing center on back buttocks,legs, arms. Some with central Itching throughout theexam.



Fleas

• Papules in non-follicular pattern

• Linear or in clusters (breakfast, lunch, dinner)

•

Cause papular urticaria• Can cause resp. symptoms. No anaphylaxis.

• Vector: Plague, Typhus, Bartonella



Flea Treatment

• Symptomatic Treatment

– H1 blocker for pruritis (loratadine, cetirizine)

– Topical steroids

• Eliminate infestation.

– “Flea bomb”

– Pet Collars/Treatments

• Professional Insecticides



Bedbugs



Bedbugs

• Typically bite at night.

• Sx start morning after and up to 10 days later.

•

Typical sites: Face, neck, hands, arms (exposedskin)

• Signs: fecal stains, blood spots, shed skins,

carcasses, eggs and live bed bugs.

• Unclear if vector for disease but have been

shown to carry Hep B/C, Chagas, HIV.



Bedbugs



Treatment

• Symptomatic Management:

– Topical steroids

– H1 blockers

• Environmental: – Wash/dry clothes, Vacuum

– Super heating room: 50 C x 90 mins

–

Card Method• Professional Insecticides:

– Organophosphates



Bedbugs vs Fleas

• Flea Trap

• Check your pet carefully.

• These include: fecal stains (aka blood spots),

shed skins, carcasses, eggs and live bed bugs.

• Look for bugs in mattress, box spring & bedframe. Search all the seams, cracks & crevices

where BBs may hide and/or place their fecalstains & eggs. Note that at 1 mm eggs are tinyand difficult to see.



Flea Trap

• Soap

• Water

• Light

so much itching

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