“You can get past the dead end. You can break through the ceiling. I did and so have countless others.”

Clinical Pearl Wednesday #20

Inspect your patients’ skin!

Whatever a patient is complaining about, inspect the area of concern! You know how many times I have made an easy diagnosis simply by lifting a shirt and taking a look?

If a patient is complaining of abdominal or back pain, take a look at their skin. I have picked up shingles on a patient’s abdomen multiple times when that morning they went to the ER and had a negative abdominal pain work up (CT, labs, etc.). The patient underwent an expensive and unnecessary work up for shingles… I bet they documented the skin was without rash too.

Same goes for back pain. Unnecessary prescriptions, x-rays, CT scans for a severe back pain complaint when all it was shingles…

This is also common with headaches. Take look at the persons scalp! Inspect and palpate it. Sometimes you can find a rash to explain the pain! I have seen folliculitis, shingles, and cellulitis which explained the headache on numerous occasions.

Sometimes we forget to do this elementary health assessment and it ends up biting us in the ass. So remember, always inspect the skin!

3 Responses

  1. Yes so true and if they have folds, lift the folds while standing to the side of the patient, could be an abscess brewing. Pt had 2 ED visits with extensive renal work up only to discover he had a large abscess under a back fold.

  2. This is excellent advice; though sometime the symptoms patients are experiencing may be the prodromal and no rash may be present. This personally happened to me – – I had what I thought was an intractable migraine. I went to the ER and was given IV fluids and migraine cocktail and discharge home. After the medications wore off, my headache intensified. In addition to photosensitivity I had visual disturbances. I went back to the ER; a CT scan was done. I was diagnosed with an “atypical migraine.” It was not until 2-3 days when vesicles began to appear on my face.

  3. Love all the pearls you share with us. I often see this, where the clinician does not inspect a pt’s skin. Thanks for all the great info!

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