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Purpura, Emergency Medicine

Richard E. Wolfe and Ashley L. Greiner Reviewed 06/2017
 


Basics

Description

  • Skin lesionscaused by extravasation of blood into the skin or subcutaneous tissue

  • Can be caused by fragile capillaries, poor dermal support, and/or platelet dysfunction

  • The resultant l...

Diagnosis

Signs and Symptoms

  • Palpable or nonpalpable, nonblanching lesions

  • Size:

    • Petechiae (≤4 mm)

    • Macular (5–10 mm)

    • Ecchymoses (>1 cm)

  • Shape:

    • Round lesions: Caused by leukocytoclastic emboli

    • Irregular (re...

Treatment

Pre-Hospital

  • IV access

  • Monitor for:

    • Fever

    • Hypotension

    • Altered mental status

Initial Stabilization/Therapy

  • For fever, hypotension, altered mental status, or generalized ecchymoses:

    • Airway support

    • IV a...

Follow-Up

Disposition

Admission Criteria

  • Unstable vital signs

  • Altered mental status

  • Fever

Discharge Criteria

Exclusion of life-threatening etiologies: 
  • Serious bacterial infections

  • Critical thrombocytopenia

Issues for Referral

Pearls and Pitfalls

Consider empiric antibiotics to cover for meningococcemia, Rocky Mountain Spotted fever, and/or sepsis if any doubt of underlying infection 

Additional Reading

  • Baselga  E. Purpura in infants and children. J Am Acad Dermatol.  1997;37:673–705.

  • Coller  BS, Schneiderman  PI. Clinical evaluation of hemorrhagic disorders: The bleeding histo...

Codes

ICD9

  • 287.0 Allergic purpura

  • 287.2 Other nonthrombocytopenic purpuras

  • 287.31 Immune thrombocytopenic purpura

ICD10

  • D69.0 Allergic purpura

  • D69.2 Other nonthrombocytopenic purpura

  • D69.3 Immune thrombocyto...

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