Serious skin signs in sick patients
In emergency medicine and critical care it is essential to be able to recognise skin signs that signify serious disease, and be able to consider the likely causes.
Hirsutism DDx
Hirsutism is abnormal growth of hair on a person's face and body, especially in females.
Splinter haemorrhages DDx
Splinter hemorrhages are lesions caused by linear bleeding under a fingernail or toenail, resembling a splinter.
Meropenem
Meropenem: carbapenem; inhibits cell wall synthesis; empiric treatment for severe sepsis
Midazolam
Midazolam: imidazobenzodiazepine; act via benodiazepine receptor in CNS; linked and facilitate action of the GABA receptor; chloride channel activation -> hyperpolarises membrane.
Thickened tethered skin DDx
Thickened tethered skin is usually suggestive of an underlying rheumatological/ immune condition.
Milrinone
Milrinone: bipyridine; non receptor mediated inhibitor of cAMP phosphodiesterase III isoenzyme -> decrease the hydrolysis of cAMP; increase cAMP (analogous to activating a Gs protein)
Morphine
Morphine: opioid analgesic; mu and kappa receptor agonist; increase intracellular Ca2+ -> increased K+ conductance -> hyperpolarisation of excitable cell membranes -> decrease in pre & post synaptic responses; reversed by naloxone
N-acetylcysteine
N-acetylcysteine (NAC): glutathione supplementation ? protects the liver by maintaining and restoring glutathione levels or by acting as an alternate substrate for conjugation with -> detoxification of reactive metabolites.
Naloxone
Naloxone: opioid receptor antagonist; competitive antagonism at mu, kappa and delta receptors -> prevention of binding to endogenous and exogenous opiate receptors.
Noradrenaline
Noradrenaline (norepinephrine) hypotension refractory to fluid resuscitation (primarily distributive shock such as septic shock, neurogenic shock, post-bypass vasoplegia and drug-induced)
NSAIDs
NSAIDS: Nonsteroidal anti-inflammatory drugs; non-selective COX inhibitors