IMAGES IN EMERGENCY MEDICINE Jennifer E. Sanders, MD; Ee Tein Tay, MD 0196-0644/$-see front matter Copyright © 2014 by the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2013.10.019
Figure 1. Erythematous serpiginous rash noted on the trunk and face. Some targetoid lesions are noted.
Figure 2. Erythematous serpiginous rash noted on the back, with some circular lesions with central clearing.
[Ann Emerg Med. 2014;64:119.] A 13-month-old boy without any medical history presented to the pediatric emergency department with 3 days of nonpruritic rash (Figures 1 and 2). Initially, the rash consisted of purple lesions that started on the back and then developed into red and raised lesions to his face, chest, and abdomen. He had no history of recent fever, respiratory symptoms, vomiting, diarrhea, or new exposures to food, travel, lotions, or detergents. Amoxicillin was begun 1 week ago for otitis media. Physical examination revealed a well-appearing child with multiple erythematous, serpiginous, and raised border lesions on his back, forehead, and trunk. There was no mucosal involvement. The rest of the examination was noncontributory.
For the diagnosis and teaching points, see page 136. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com Volume 64, no. 2 : August 2014
Annals of Emergency Medicine 119
Measuring Patient Tolerance for Future Adverse Events 6. Stacey D, Bennett CL, Barry MJ, et al. Decision aids for people facing health treatment of screening decisions. Cochrane Database Syst Rev. 2011;(10):CD001431. 7. von Neumann J, Morgenstern O. Theory of Games and Economic Behavior. Princeton, NJ: Princeton University Press; 1947. 8. Tversky A, Kahneman D. Advances in prospect theory: cumulative representations of uncertainty. J Risk Uncertainty. 1988;5:297-323. 9. Edwards A, Elwyn G, Covey J, et al. Presenting risk information—the effects of “framing” and other manipulations on patient outcomes. J Health Commun. 2001;6:61-82. 10. Brown TB, Cofield SS, Iyer A, et al. Assessment of risk tolerance for adverse events in emergency department chest pain patients: a pilot study. J Emerg Med. 2010;39:247-252. 11. Davis MA, Keerbs A, Hoffman JA, et al. Admissions decisions in emergency department chest pain patients at low risk for myocardial infarction: patient versus physician preferences. Ann Emerg Med. 1996;28:606-611. 12. Kline JA, Zeitouni RA, Hernandez-Nino J, et al. Randomized trial of computerized quantitative pretest probability in low-risk chest pain patients: effect on safety and resource use. Ann Emerg Med. 2009;53:727-735. 13. Hess EP, Knoedler MA, Shah ND, et al. The chest pain choice decision aid: a randomized trial. Circ Cardiovasc Qual Outcomes. 2012;5:251-259. 14. Greenwood PJ, Ellis LB, Gross CR. Knowledge gains from a computerbased health risk appraisal. Proc Annu Symp Comput Appl Med Care. 1991;173-176. 15. Ende J, Kazis LE, Ash A, et al. Measuring patients’ desire for autonomy. J Gen Intern Med. 1989;4:23-30. 16. Grimes DA, Snively GR. Patients’ understanding of medical risks: implications for genetic counseling. Obstet Gynecol. 1999;93:910-914. 17. Lipkus IM, Hollands JG. The visual communication of risk. J Natl Cancer Inst Monogr. 1999;25:149-162.
136 Annals of Emergency Medicine
Chen et al 18. Edwards A, Elwyn G, Mulley A. Explaining risks: turning numerical data into meaningful pictures. BMJ. 2002;324:827-830. 19. Hux JE, Naylor CD. Communicating the benefits of chronic preventive therapy: does the format of efficacy data determine patients’ acceptance of treatment? Med Decis Making. 1995;15: 152-157. 20. Marewski JN, Gigerenzer G. Heuristic decision making in medicine. Dialogues Clin Neurosci. 2012;14:78-89. 21. Kurz-Milcke E, Gigerenzer G, Martignon L. Transparency in risk communication. Ann N Y Acad Sci. 2008;1128:18-28. 22. Klein G. Naturalistic decision making. Hum Factors. 2008;50: 456-460. 23. March JG. Theories of Choice and Making Decisions. Society. 1982;20(1):29-39. 24. Taylor-Gooby P, Zinn JO. Current directions in risk research: new developments in psychology and sociology. Risk Anal. 2006;26: 397-411. 25. Hall MA, Dugan E, Zheng B, et al. Trust in physicians and medical institutions: what is it, can it be measured, and does it matter? Milbank Q. 2001;79:613-639. 26. Glasgow RE, Strycker LA, Hampson SE, et al. Personal-model beliefs and social-environmental barriers related to diabetes selfmanagement. Diabetes Care. 1997;20:556-561. 27. Finucane ML, Slovic P, Mertz CK, et al. Gender, race, and perceived risk: the “white male” effect. Healthy Risk Soc. 2000;2:159-172. 28. Gustafson PE. Gender differences in risk perception: theoretical and methodological perspectives. Risk Anal. 1998;18:805-811. 29. Shamoun S, Svenson O. Value conflict and post-decision consolidation. Scand J Psychol. 2002;43:325-333. 30. Janz NK, Becker MH. The health belief model: a decade later. Health Educ Q. 1984;11:1-47. 31. O’Connor AM, Rostom A, Fiset V, et al. Decision aids for patients facing health treatment or screening decision: systematic review. BMJ. 1999;319:731-734.
Volume 64, no. 2 : August 2014
Figure 1. Erythematous serpiginous rash noted on the trunk and face. Some targetoid lesions are noted.
Figure 2. Erythematous serpiginous rash noted on the back, with some circular lesions with central clearing.
[Ann Emerg Med. 2014;64:119.] A 13-month-old boy without any medical history presented to the pediatric emergency department with 3 days of nonpruritic rash (Figures 1 and 2). Initially, the rash consisted of purple lesions that started on the back and then developed into red and raised lesions to his face, chest, and abdomen. He had no history of recent fever, respiratory symptoms, vomiting, diarrhea, or new exposures to food, travel, lotions, or detergents. Amoxicillin was begun 1 week ago for otitis media. Physical examination revealed a well-appearing child with multiple erythematous, serpiginous, and raised border lesions on his back, forehead, and trunk. There was no mucosal involvement. The rest of the examination was noncontributory.
For the diagnosis and teaching points, see page 136. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com Volume 64, no. 2 : August 2014
Annals of Emergency Medicine 119
Measuring Patient Tolerance for Future Adverse Events 6. Stacey D, Bennett CL, Barry MJ, et al. Decision aids for people facing health treatment of screening decisions. Cochrane Database Syst Rev. 2011;(10):CD001431. 7. von Neumann J, Morgenstern O. Theory of Games and Economic Behavior. Princeton, NJ: Princeton University Press; 1947. 8. Tversky A, Kahneman D. Advances in prospect theory: cumulative representations of uncertainty. J Risk Uncertainty. 1988;5:297-323. 9. Edwards A, Elwyn G, Covey J, et al. Presenting risk information—the effects of “framing” and other manipulations on patient outcomes. J Health Commun. 2001;6:61-82. 10. Brown TB, Cofield SS, Iyer A, et al. Assessment of risk tolerance for adverse events in emergency department chest pain patients: a pilot study. J Emerg Med. 2010;39:247-252. 11. Davis MA, Keerbs A, Hoffman JA, et al. Admissions decisions in emergency department chest pain patients at low risk for myocardial infarction: patient versus physician preferences. Ann Emerg Med. 1996;28:606-611. 12. Kline JA, Zeitouni RA, Hernandez-Nino J, et al. Randomized trial of computerized quantitative pretest probability in low-risk chest pain patients: effect on safety and resource use. Ann Emerg Med. 2009;53:727-735. 13. Hess EP, Knoedler MA, Shah ND, et al. The chest pain choice decision aid: a randomized trial. Circ Cardiovasc Qual Outcomes. 2012;5:251-259. 14. Greenwood PJ, Ellis LB, Gross CR. Knowledge gains from a computerbased health risk appraisal. Proc Annu Symp Comput Appl Med Care. 1991;173-176. 15. Ende J, Kazis LE, Ash A, et al. Measuring patients’ desire for autonomy. J Gen Intern Med. 1989;4:23-30. 16. Grimes DA, Snively GR. Patients’ understanding of medical risks: implications for genetic counseling. Obstet Gynecol. 1999;93:910-914. 17. Lipkus IM, Hollands JG. The visual communication of risk. J Natl Cancer Inst Monogr. 1999;25:149-162.
136 Annals of Emergency Medicine
Chen et al 18. Edwards A, Elwyn G, Mulley A. Explaining risks: turning numerical data into meaningful pictures. BMJ. 2002;324:827-830. 19. Hux JE, Naylor CD. Communicating the benefits of chronic preventive therapy: does the format of efficacy data determine patients’ acceptance of treatment? Med Decis Making. 1995;15: 152-157. 20. Marewski JN, Gigerenzer G. Heuristic decision making in medicine. Dialogues Clin Neurosci. 2012;14:78-89. 21. Kurz-Milcke E, Gigerenzer G, Martignon L. Transparency in risk communication. Ann N Y Acad Sci. 2008;1128:18-28. 22. Klein G. Naturalistic decision making. Hum Factors. 2008;50: 456-460. 23. March JG. Theories of Choice and Making Decisions. Society. 1982;20(1):29-39. 24. Taylor-Gooby P, Zinn JO. Current directions in risk research: new developments in psychology and sociology. Risk Anal. 2006;26: 397-411. 25. Hall MA, Dugan E, Zheng B, et al. Trust in physicians and medical institutions: what is it, can it be measured, and does it matter? Milbank Q. 2001;79:613-639. 26. Glasgow RE, Strycker LA, Hampson SE, et al. Personal-model beliefs and social-environmental barriers related to diabetes selfmanagement. Diabetes Care. 1997;20:556-561. 27. Finucane ML, Slovic P, Mertz CK, et al. Gender, race, and perceived risk: the “white male” effect. Healthy Risk Soc. 2000;2:159-172. 28. Gustafson PE. Gender differences in risk perception: theoretical and methodological perspectives. Risk Anal. 1998;18:805-811. 29. Shamoun S, Svenson O. Value conflict and post-decision consolidation. Scand J Psychol. 2002;43:325-333. 30. Janz NK, Becker MH. The health belief model: a decade later. Health Educ Q. 1984;11:1-47. 31. O’Connor AM, Rostom A, Fiset V, et al. Decision aids for patients facing health treatment or screening decision: systematic review. BMJ. 1999;319:731-734.
Volume 64, no. 2 : August 2014
