bullous impetigo

Diagnosis
bullous impetigo
Body Site
face scalp arm chest
Age
13 months
Pigmentation
light
Organization
discrete confluent
Color
red
Morphology
vesiculobullous (blister, pustule)
Pattern
generalized, disseminated symmetric
Comments
This healthy 13-month-old girl started with a few blisters on her cheeks a week ago. The lesions
disseminated over the face, scalp, trunk and extremities. Although fussy, she was afebrile,
drinking well, and the mucous membranes were spared.
Description
discrete and confluent superficial vesicles, bullae, and erosions with purulent exudate
referensi:
http://dermatlas.med.jhmi.edu/image/disseminated_bullous_impetigo_5_110702
Criteria of an EKG with inferior myocardial infarction

1. Q waves greater than 0.04 sec duration in II, III, and aVF.

2. ST segment elevation in these leads in acute infarction.

3. T wave inversion in these leads with old or evolving infarction.

4. Often there is a lateral wall component in inferior wall myocardial infarction which produces
T wave changes in leads V4-V6.

Criteria of Anterior and Anterolateral Myocardial Infarction

1. Absent R wave in V2-V5 (QS wave).

2. ST segment elevation in these leads in acute infarction.

3. T wave inversion in these leads in old or evolving infarction.

4. Q waves in leads I, aVL and V6 with ST segment elevation in these leads is evidence of
additional infarction of the high anterior lateral wall.

Criteria of systolic(pressure) overloading LVH

I. Voltage criteria
Limb leads
1. Lead I: R > 15 mm or R > 18 mm with left axis deviation (LAD)
2. Lead aVL: R > 12 mm or R > 16 mm with LAD
3. Lead II or III: R > 25 mm
Precordial leads

1. V5 > 26 mm
2. Sum of S wave in V2 and R wave in V5 > 36 mm
3. V6 > V5
Orthogonal leads

1. Transverse plane mean QRS vector > 20 mm

2. Frontal plane mean QRS vector > 25 mm

II. Secondary ST-T changes

III. Increased QRS duration

Intrinsicoid deflection > .09 sec

Incomplete Left Bundle Branch Block (ILBBB)

Loss of R wave in V1 and V2

IV. P wave abnormality of left atrial enlargement (LAE)

Criteria of diastolic(volume) overloading LVH

I. Voltage Criteria
Limb leads
1. Lead I: R > 15 mm or R > 18 mm with left axis deviation (LAD)
2. Lead aVL: R > 12 mm or R > 16 mm with LAD
3. Lead II or III: R > 25 mm
Precordial leads

1. V5 > 26 mm
2. Sum of S wave in V2 and R wave in V5 > 36 mm
3. V6 > V5
Orthogonal leads

1. Transverse plane mean QRS vector > 20

2. Frontal plane mean QRS vector > 25

II. Tall, peaked T-waves in leads I, aVL, V5, and V6

III. Increased QRS duration

Instrinsicoid deflection > .09 sec.

Deep Q-waves in leads I, aVL, V5, and V6

IV. P-wave abnormality of left atrial enlargement (LAE)

Criteria of right bundle branch block

I. QRS
Duration
1. Complete RBBB is > 0.13 sec.
 2. Incomplete RBBB is between 0.09 and 0.12 sec.
Morphology

1. Precordial leads
V1 = rsR' with CRBBB or V1 = rSr' with IRBBB.

V6 = qRs with CRBBB or IRBBB

2. Limb leads
Axis can be right, left, or normal.

Ignore terminal 0.08 vector when calculating axis.

Lead I = qRs.

3. Orthogonal leads
Lead X = qRS (with IRBBB = qrS)

Lead Z = qRS (with CRBBB = qRs)

II. T wave is always in the opposite direction from terminal S wave.

III. Conduction abnormalities

Both LAFB and LPFB can occur with RBBB using usual criteria.
LVH, ASMI, AMI, ACMI, and IMI can all be diagnosed with RBBB using usual criteria.