IMAGES IN EMERGENCY MEDICINE Shawna D. Bellew, MD; Tobias Kummer, MD 0196-0644/$-see front matter Copyright © 2015 by the American College of Emergency Physicians. http://dx.doi.org/10.1016/j.annemergmed.2014.05.004
Figure 1. Diffuse, pruritic, erythematous rash involving the majority of the body surface.
Figure 2. A close-up of the rash shows erythematous plaques with overlying pustules and isolated bullae.
[Ann Emerg Med. 2015;65:146.] A 55-year-old woman presented to the emergency department with a 2-week history of pruritic rash and progressive weakness. The eruption, first affecting the abdomen, appeared 9 days after initiation of vancomycin and cefepime (Figure 1). The patient had a temperature of 38.4 C (101.12 F) and a pulse rate of 160 beats/min. Physical examination revealed diffuse, edematous, erythematous plaques with overlying pustules and isolated bullae (Figure 2). The oral mucosa was not involved. Laboratory investigation identified an elevated lactate level of 6.4 mmol/L and a leukocyte count of 28.9109/L.
Further discussion of this case can be found on page 147. For the diagnosis and teaching points, see page 161. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com 146 Annals of Emergency Medicine
Volume 65, no. 2 : February 2015
Ward et al 21. Schulman PR. The negotiated order of organizational reliability. Administration Soc. 1993;25:353-372. 22. Weick KE, Roberts KH. Collective mind in organizations—heedful interrelating on flight decks. Admin Sci Q. 1993;38:357-381. 23. Madsen P, Desai V, Roberts K. Mitigating hazards through continuing design: the birth and evolution of a pediatric intensive care unit. Organ Sci. 2006;17:239-248. 24. Vogus TJ, Sutcliffe KM. The Safety Organizing Scale: development and validation of a behavioral measure of safety culture in hospital nursing units. Med Care. 2007;45:46-54.
Volume 65, no. 2 : February 2015
Operational Flexibility in the Emergency Department 25. Law AM, Kelton WD. Simulation Modeling and Analysis. Vol 2. New York, NY: McGraw-Hill; 1991. 26. Ferrand Y, Magazine M, Rao U. Partially flexible operating rooms for elective and emergency surgeries. Decision Sci. 2014; http://dx.doi. org/10.1111/deci.12096. 27. Koste LL, Malhotra MK. A theoretical framework for analyzing the dimensions of manufacturing flexibility. J Oper Manag. 1999;18:75-93. 28. Wildavsky AB; Bowling Green State University; Social Philosophy & Policy Center. Searching for Safety. New Brunswick, NJ: Transaction Books; 1988.
Annals of Emergency Medicine 161
Figure 1. Diffuse, pruritic, erythematous rash involving the majority of the body surface.
Figure 2. A close-up of the rash shows erythematous plaques with overlying pustules and isolated bullae.
[Ann Emerg Med. 2015;65:146.] A 55-year-old woman presented to the emergency department with a 2-week history of pruritic rash and progressive weakness. The eruption, first affecting the abdomen, appeared 9 days after initiation of vancomycin and cefepime (Figure 1). The patient had a temperature of 38.4 C (101.12 F) and a pulse rate of 160 beats/min. Physical examination revealed diffuse, edematous, erythematous plaques with overlying pustules and isolated bullae (Figure 2). The oral mucosa was not involved. Laboratory investigation identified an elevated lactate level of 6.4 mmol/L and a leukocyte count of 28.9109/L.
Further discussion of this case can be found on page 147. For the diagnosis and teaching points, see page 161. To view the entire collection of Images in Emergency Medicine, visit www.annemergmed.com 146 Annals of Emergency Medicine
Volume 65, no. 2 : February 2015
Ward et al 21. Schulman PR. The negotiated order of organizational reliability. Administration Soc. 1993;25:353-372. 22. Weick KE, Roberts KH. Collective mind in organizations—heedful interrelating on flight decks. Admin Sci Q. 1993;38:357-381. 23. Madsen P, Desai V, Roberts K. Mitigating hazards through continuing design: the birth and evolution of a pediatric intensive care unit. Organ Sci. 2006;17:239-248. 24. Vogus TJ, Sutcliffe KM. The Safety Organizing Scale: development and validation of a behavioral measure of safety culture in hospital nursing units. Med Care. 2007;45:46-54.
Volume 65, no. 2 : February 2015
Operational Flexibility in the Emergency Department 25. Law AM, Kelton WD. Simulation Modeling and Analysis. Vol 2. New York, NY: McGraw-Hill; 1991. 26. Ferrand Y, Magazine M, Rao U. Partially flexible operating rooms for elective and emergency surgeries. Decision Sci. 2014; http://dx.doi. org/10.1111/deci.12096. 27. Koste LL, Malhotra MK. A theoretical framework for analyzing the dimensions of manufacturing flexibility. J Oper Manag. 1999;18:75-93. 28. Wildavsky AB; Bowling Green State University; Social Philosophy & Policy Center. Searching for Safety. New Brunswick, NJ: Transaction Books; 1988.
Annals of Emergency Medicine 161
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