Rash, Wounds & Burns

“There are several rare life-threatening skin conditions, or manifestations of systemic disease, that may be missed by the emergency physician who is not familiar with them.”

CAP 28 – Rash

EM Curriculum: (click to view)

Dermatology

Dermatology can appear daunting because of the large number of different terms used to describe clinical findings, this makes it almost like learning a new language. Also these clinical findings are often the main part of the diagnostic process without further investigations.

Rashes

A rash is a common presentation to the emergency department (ED) and may be a sign of serious illness or systemic disease. Signs and symptoms can therefore be purely dermatological, or a manifestation of a systemic condition.

There are also several rare, life-threatening skin conditions, or manifestations of systemic disease, that may be missed by the emergency physician who is not familiar with them.

Minor Injuries

Minor injuries and wounds are an extremely common presentation to A+E with many units having their own minor injury units or walk in centre to deal specifically with minor injuries.

In recent studies it has been demonstrated that junior doctors are becoming less experienced and less proficient in the assessment and management of minor injuries.

All tissue injuries are liable to cause complications, and some of these if not recognised or treated can be limb or life threatening. Knowing how to assess and manage minor injuries as well as being aware of the complications is essential to avoiding infection, compartment syndrome and tetanus.

Burns

There are approximately a quarter of a million burn injuries in the UK each year, and about 175,000 presentations to A+E each year. This in turn leads to some 13,000 admissions to hospital each year. 

While many make a good recovery from burns, there are still about 300 people who die each year due to burns or complications of burns. Many of these patients are elderly. 

Burns can cause a number of severe complications, and some of which may present to the A+E department. Thus knowing how to assess, and when to refer burns (and to which department) is crucial in the management of this patient group.

Remember: When assessing a patient with a rash, wound or burns always consider the following:
  1. Could this be a systemic disease process?
  2. Does this patient require tetanus vaccination?
  3. How contaminated is this wound, and what level of cleaning is required?
  4. What was the mechanism of injury? (could there be injuries elsewhere?)
  5. Consider the emergency presentations of burns (circumfrential, airway, chemical, electrical)

LEARNING OUTCOMES FROM THE TASKS

  • Describe the salient history and examination points behind the assessment of a dermatological presentation.
  • Explain the classifications of wounds, and the process of and factors affecting wound healing.
  • Explain the techniques available to you for wound closure and when they can be employed.
  • Assess the depth of a burn.

Learning Outcome from face-to-face teaching

  • Recognise and formulate a management plan for dermatological emergencies.
  • Explain the management of complex skin wounds.
  • Describe the various ways of delivering anaesthesia for wound closure.
  • Formulate a management plan for a burn.
  • Know the common complications of dermatological emergencies, wounds and burns and how these might present to the Emergency Department.

Tasks

Complete the following before the face to face session:

Task 1: Dermatological Examination

Duration: 45 mins

This module covers all the basics of dermatology pertaining to the Emergency Department. Click on the screenshot or link below to access it. It is taken from the RCEMLearning website which contains curriculum mapped modules, if it is your first visit to the website take a look around for many useful resources.

Task 2: Wound Healing & Assessment

Duration: 60 mins

eLearning For Health remains a challenging platform to use, but as ever the content itself is good. These modules produced for the plastics course have the endorsement of BAPRAs and cover the essentials needed.

Remember that to access this module you will have to have subscribed to the plastic surgery course on e-learning for health and you may also need to enable pop-ups

Task 3: Remember, Remember... Burns & Scalds

Duration: 30 mins

This summary article from #EM3 serves as an introduction to burn injuries, there are also several links for further reading/ activities if you want to know more.

#EM3 Content

LIGHTNING LEARNING

Mini Teaches:

EMERGENCY PROTOCOLS

You should familiarise yourself with relevant Local Guidelines, but for East Midlands Trainees we are aiming to host these on the website shortly (although this may password protected).

In the meantime please review your local guidelines relevant to Rashes, Wounds and Burns.

CASE DISCUSSION

We have written a series of interactive cases (wikis) with short answer questions to be answered by trainees prior to the face to face teaching sessions. Currently this is only available to East Midlands Trainees.

Answer one or two questions before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. We will also provide tutor comments. If you find good resources that answer a question why not include links in your comment.

Part of the face-to-face teaching will be spent discussing the case(s) below:

“A 30 year old man is brought into Resus having had a fight with his partner, who boiled a kettle and threw the contents over his chest.”
“Describe/define each of the following terms...”

Additional Resources

Life in the Fast Lane:

Two articles from the Life In the Fast Lane blog on the management of burns:

  1. Major Burns
  2. Minor Burns

Between them they cover the assessment of depth and size of burns, fluid calculations. As well as which burns can be managed as an outpatient and which require admission or even referral to specialist burns centres.

Course Feedback

Once you have worked through the exercises, discussed the example cases and attended the face-to-face teaching, please complete the following form: