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Skin Discoloration

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101. Recommendation for Record-Keeping

size/body mass index (BMI) Vital signs—pulse, blood pressure Extraoral examination Facial features Nasal breathing Lip posture Symmetry Pathologies Skin health TMJ / TMD 16 Signs of clenching/bruxism Headaches from TMD Pain Joint sounds Limitations or disturbance of movement or function Intra-oral soft tissue examination Tongue Roof of mouth Frenulae Floor of mouth Tonsils/pharynx Lips Pathologies noted Oral hygiene and periodontal assessment 29,30 Oral hygiene, including an index or score Gingival (...) tissue examination Teeth present Supernumerary/missing teeth Dental development status Over-retained primary teeth Ankylosed teeth Ectopic eruption Anomalies/pathologies noted Tooth size, shape discrepancies Tooth discoloration Enamel hypoplasia/fluorosis Congenital defects Existing restorations Defective restorations Caries Pulpal pathology 31,32 Traumatic injuries Third molars Radiographic examination 33 Developmental anomalies Eruptive patterns/tooth positions/root resorption Crestal alveolar bone

2017 American Academy of Pediatric Dentistry

102. Oral and Dental Aspects of Child Abuse and Neglect

and discolored. 11,12 Gags applied to the mouth may result in bruises, lichenification, or scarring at the corners of the mouth. 13 Some serious injuries of the oral cavity, including posterior pharyngeal injuries and retropharyngeal abscesses, may be inflicted by caregivers who fabricate illness in a child 14 ABBREVIATIONS AAP: American Academy of Pediatrics. ABFO: American Board of Forensic Odontology. To cite: Fisher-Owens SA, Lukefahr JL, Tate AR, American Academy of Pediatric Den- tistry, Council (...) is suspicious for an adult human bite. 37 Bite marks found on human skin are challenging to inter- pret because of the distortion presented and the time elapsed between the injury and the analysis. 36 Recent investigations have led to questions about the scientific validity of forensic patterned evidence (bite mark analysis in particular) and its role in legal proceedings. 38 The pattern, size, contour, and color of a bite mark ideally can be evaluated by a forensic odon- tologist; a forensic pathologist

2017 American Academy of Pediatric Dentistry

103. British Association of Dermatologists guidelines for the management of pemphigus vulgaris

and less likely to achieve remission off-treatment than purely mucosal PV. 13 6.1 Clinical presentation The diagnosis of PV should be suspected in any patient with mucocutaneous erosions or blisters. The oral mucosa is the ?rst site of involvement in the majority of cases, and PV may remain con?ned to the mucosal surfaces or extend to involve the skin (average lag period of 4 months). 14–16 Diagnostic delay is very common when PV is con?ned to the oral mucosa. 17 A minority of patients will present (...) with cutaneous erosions, but oral erosions will, eventually, occur in most cases. PV presents across a wide age range with peak fre- quency in the third to sixth decades. 7.0 Laboratory diagnosis Perilesional skin biopsies should be taken for histology and direct immuno?uorescence (DIF). In patients with isolated oral disease, a histology specimen should be taken from per- ilesional mucosa and a DIF sample taken from an uninvolved area, ideally from the buccal mucosa. 18 Suprabasal acantholysis with blister

2017 British Association of Dermatologists

104. CrackCAST E129 – Bacteria

rapidly. Antimicrobial therapy should be initiated promptly, before identification of an organism. [1] Describe the clinical features, diagnostic tests and management of Diphtheria. Humans are the only known reservoir for Corynebacterium diphtheriae . Spread is by person-to-person through respiratory droplets or by direct contact with secretions, skin lesion exudates, or rarely fomites or food . Transmission is associated with crowded living conditions. Individuals may spread the disease when (...) for the primary location of infection. Cutaneous diphtheria can occur as a primary skin infection or as a secondary infection of a preexisting wound. Circulating exotoxin causes the systemic symptoms of diphtheria, most profoundly affecting the nervous system, heart, and kidneys. Progression of symptoms/signs: Generic URTI symptoms Low grade fever and sore throat are the most frequent presenting complaints. Weakness, dysphagia, headache, voice changes, and loss of appetite ⅓ develop cervical lymphadenopathy

2017 CandiEM

105. CRACKCast E064 – Chemical Injuries

in Perspective Chemicals are everywhere, >10,000 new ones are made every year → be afraid! Most susceptible organs: skin, eyes, lungs Most commonly release substances: Volatile organic compounds (VOC’s) Herbicides Acids Ammonia Cement Drain cleaner Gasoline Pathophysiology: Most cause damage through a chemical reaction with the skin 1) Describe the difference between Alkali and Acid injuries Acidic compounds: Cause protein denaturation and coagulative necrosis with the skin The necrosis forms eschar → which (...) LIMITS the depth of acid penetration Their free hydrogen ions are easily neutralized on the skin by copious water irrigation Alkali compounds: Produce saponification and liquefactive necrosis of body fat – they produce soluble protein complexes which “permit the passage of hydroxyl ions deep into the tissue” and limiting the contact of the alkali complex on the surface of the skin. Because there is no eschar formation they usually penetrate DEEPER into the tissue 2) Describe a HAZMAT response

2017 CandiEM

106. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals ? protocol version 5.3

, OTHER THAN PNEUMONIA 64 GI: GASTROINTESTINAL SYSTEM INFECTION 65 REPR: REPRODUCTIVE TRACT INFECTION 67 SST: SKIN AND SOFT TISSUE INFECTION 68 SYS: SYSTEMIC INFECTION 70 NEO: SPECIFIC NEONATAL CASE DEFINITIONS 71 Algorithm for diagnosis of catheter-related infections 72 Microorganism code list 73 Microorganism code list (PPS selection), by category 73 Antimicrobial resistance markers and codes 77 Surgery categories 78 NHSN surgery codes 78 Examples of non-NHSN surgery 80 References 81 TECHNICAL (...) list (with only main specialties), consultant/patient specialty codes for healthy neonates added ? Diagnosis (site) code list for antimicrobial use: surgical site infection (SSI) was added as a subcategory of both skin or soft tissue infections (SST) and bone or joint infections (BJ); addition of cystic fibrosis (CF) as a separate entry ? Antimicrobial ATC codes: updated with new codes added since 2011 ? HAI case definitions: ? Surgical site infection (SSI): follow-up period of deep incisional

2016 European Centre for Disease Prevention and Control - Technical Guidance

107. AIUM Practice Parameter for the Performance of Physiologic Evaluation of Extremity Arteries

E. Preprocedure ? ?assessment ? ?of ? ?patients ? ?with ? ?chronic ? ?kidney ? ?disease ? ?requiring ? ?dialysis. ? 4,5 F. Evaluation ? ?of ? ?cold ? ?sensitivity ? ?or ? ?discoloration ? ?of ? ?extremities ? ?or ? ?digits. ? 6 G. Evaluation ? ?of ? ?suspected ? ?thoracic ? ?outlet ? ?syndrome. ? 6 H. Evaluation ? ?of ? ?a ? ?suspected ? ?steal ? ?distal ? ?to ? ?an ? ?arteriovenous ? ?fistula ? ?or ? ?graft. ? 7,8 I. Preoperative ? ?assessment ? ?for ? ?arterial ? ?harvesting. ? 9,10 J (...) ? ?to ? ?the ? ?skin ? ?in ? ?an ? ?area ? ?of ? ?questionable ? ?viability. ? 17 ? ? ?The ? ?usual ? ?locations ? ?on ? ?the ? ?lower extremities ? ?are ? ?on ? ?the ? ?foot, ? ?ankle, ? ?and ? ?calf, ? ?with ? ?a ? ?reference ? ?point ? ?on ? ?the ? ?chest. ? ? ??After ? ?the desquamated ? ?cells ? ?are ? ?cleaned ? ?from ? ?the ? ?skin, ? ?a ? ?coupling ? ?solution ? ?such ? ?as ? ?distilled ? ?water ? ?is applied ? ?to ? ?the ? ?skin, ? ?and ? ?the ? ?tcP ?O ?2 ? ??sensor ? ?is ? ?affixed

2017 American Institute of Ultrasound in Medicine

112. Prevention, Diagnosis & Management of infective endocarditis

have also shown that early surgical interventions in these patients decrease embolic complications and improve outcomes. There have also been changes with regards to antimicrobial prophylaxis. The evidence currently shows that routine antimicrobial prophylaxis prior to dental procedures is not indicated for all cardiac patients and should be limited to high- risk cardiac patients only. Maintaining a good oral and skin hygiene routine is highly recommended in the prevention of IE. With these recent (...) medical procedures and should be limited only for cardiac patients associated with the highest risk of adverse outcomes from IE (refer Chapter 8.0). • Those with high predisposing risk for developing IE should be advised to maintain good oral and skin hygiene. SUMMARY OF THE CLINICAL PRACTICE GUIDELINES FOR THE PREVENTION, DIAGNOSIS AND MANAGEMENT OF INFECTIVE ENDOCARDITIS21 SUMMARY OF THE CLINICAL PRACTICE GUIDELINES FOR THE PREVENTION, DIAGNOSIS AND MANAGEMENT OF INFECTIVE ENDOCARDITIS Summary

2017 Ministry of Health, Malaysia

113. Pressure ulcers: prevention and management

or discomfort reported by the patient and the skin should be checked for: skin integrity in areas of pressure colour changes or discoloration [2] variations in heat, firmness and moisture (for example, because of incontinence, oedema, dry or inflamed skin). All ages: care planning Develop and document an individualised care plan for neonates, infants, children, young Pressure ulcers: prevention and management (CG179) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk (...) be checked for: skin integrity in areas of pressure colour changes or discoloration [4] variations in heat, firmness and moisture (for example, because of incontinence, oedema, dry or inflamed skin). 1.1.6 Use finger palpation or diascopy to determine whether erythema or discolouration (identified by skin assessment) is blanchable. 1.1.7 Start appropriate preventative action (see recommendations 1.1.1–1.1.17) in adults who have non-blanching erythema and consider repeating the skin assessment at least

2014 National Institute for Health and Clinical Excellence - Clinical Guidelines

114. AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Neonatal and Infant Spine

: a. Midline or paramedian masses; b. Midline skin discolorations; c. Skin tags; d. Hair tufts; e. Hemangiomas; f. Small midline dimples; and g. Paramedian deep dimples; 2. The spectrum of caudal regression syndrome, including patients with sacral agenesis, anal atresia or stenosis; 2016—AIUM PRACTICE PARAMETER—Neonatal and Infant Spine 1 neonatalSpine.qxp_0616 6/29/16 4:02 PM Page 13. Evaluation of suspected cord abnormalities such as cord tethering, diastematomyelia, hydromyelia, and syringomyelia; 4 (...) abnormalities, such as syrinx or diastematomyelia. These latter abnormalities should be identified preoperatively. 2. Examination of the contents of a closed neural tube defect if the skin overlying the defect is thin or no longer intact. III. Qualifications and Responsibilities of Personnel See www.aium.org for AIUM Official Statements including Standards and Guidelines for the Accreditation of Ultrasound Practices and relevant Physician Training Guidelines. 14 IV . Written Request for the Examination

2016 American Institute of Ultrasound in Medicine

115. SNMMI Procedure Standard-EANM Practice Guideline for Amyloid PET Imaging of the Brain

calibrator prior to administration. Inspection for dose infiltration at the injection site should be routinely performed. b) Specific precautions should be taken with an amyloid PET examination: Inspect the radiopharmaceutical dose solution prior toSNMMI Procedure Standard-EANM Practice Guideline for Amyloid PET Imaging of the Brain 7 administration. It should not be used if it contains particulate matter or is discolored. The radiotracer should be injected using a short intravenous catheter (...) Skin 6 6 7 Spleen 9 16 10 Testes 7 5 9 Thymus 7 6 9 Thyroid 7 7 8 Urinary Bladder Wall 27 62 70 Uterus 16 27 16 Total Body 12 14 11 Effective Dose (µSv/MBq) 19 34 19 X. ACKNOWLEDGEMENTS Task Force Members: Satoshi Minoshima, MD, PhD (Co-Chair) (University of Utah, Salt Lake City, UT); Alexander E. Drzezga, MD (Co-Chair) (University of Cologne, Cologne, Germany); Mehdi Djekidel, MD (Yale University, New Haven, CT); David H. Lewis, MD (Harborview Medical Center, Seattle, WA); Chester A. Mathis, PhD

2016 Society of Nuclear Medicine and Molecular Imaging

116. Nonsurgical Management of Osteoarthritis of the Knee

, stinging and pain at the site of application. Local adverse events are the most commonly reported adverse events from steroid injections. These include pain on injection, redness, post injection flare and skin discoloration. The rate of joint infection is considered to be very low when strict aseptic techniques are followed. Systemic effects include rapid suppression of serum cortisol, adrenocorticotropin hormone (ACTH) and inflammatory markers (erythrocyte sedimentation rate [ESR], C-reactive protein (...) ., the elderly and patients with renal or hepatic impairment). Adverse events such as endocrine dysfunction and sleep-disordered breathing are associated with long-term opioid therapy in chronic pain. Results from two studies showed that oral diclofenac has a higher incidence of adverse GI symptoms, whereas topical diclofenac has a higher incidence of local application site reactions, commonly dry skin, rash, and pruritus. Adverse events associated with topical capsaicin are limited to temporary burning

2016 National Guideline Clearinghouse (partial archive)

117. Hirudotherapy: An Ugly Means of Avoiding Uglier Outcomes

forms of microsurgery. Their use in microsurgical operations spans a range that includes free tissue flap [1]. The revival of hirudotherapy was spurred by the 1960 paper, “Venous congestion of flaps treated by application of leeches,” by Deganc and Zdravic in the British Journal of Plastic Surgery . It sought to address a major issue plaguing reconstructive microsurgery at the time: the “blue flap.” This term referred to the ominous discoloration seen in a flap that had become cyanotic, [2 (...) ]. To improve blood flow, the pair introduced Hirudo medicinalis , a species of leech native to Europe. In a series of 20 cases of venous congestion, Deganc and Zdravic allowed leeches to bite and attach to patients’ skin and then suck blood from the tissue until they detached of their own volition. A 70% success rate for complete restoration of blood flow was observed, while the other 30% of patients in the cohort experienced at least partial decongestion. Deganc and Zdravic proposed a dual mechanism

2016 Clinical Correlations

119. Acne clinical guideline

process. Available at: . Accessed January 4, 2016. This guideline will be considered current for a period of 5 years from the date of publication, unless reaffirmed, updated, or retired at or before that time. Definition AV is a chronic inflammatory dermatosis notable for open or closed comedones (blackheads and whiteheads) and inflammatory lesions, including papules, pustules, or nodules (also known as cysts). Introduction Acne is a common skin disease, especially in adolescents and young adults (...) is a multifactorial inflammatory disease affecting the pilosebaceous follicles of the skin. The current understanding of acne pathogenesis is continuously evolving. Key pathogenic factors that play an important role in the development of acne are follicular hyperkeratinization, microbial colonization with Propionibacterium acnes , sebum production, and complex inflammatory mechanisms involving both innate and acquired immunity. In addition, studies have suggested that neuroendocrine regulatory mechanisms, diet

2016 American Academy of Dermatology

120. Neuroblastoma Treatment (PDQ®): Health Professional Version

syndrome without other apparent cause are also examined for neuroblastoma and other tumors.[ ] Subcutaneous skin nodules: Subcutaneous metastases of neuroblastoma often have bluish discoloration of the overlying skin and is usually seen only in infants. The clinical presentation of neuroblastoma in adolescents is similar to the clinical presentation in children. The only exception is that bone marrow involvement occurs less frequently in adolescents, and there is a greater frequency of metastases

2018 PDQ - NCI's Comprehensive Cancer Database

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