Erythema Multiforme Case at Hospital Cayetano, Peru

August 16, 2016

Hospital Nacional Cayetano Heredia

 

10:30 AM: Today, I attended morning rounds in the Pediatrics Ward.  There were two attending physicians, one visiting doctor, one resident and five medical students all gathering around each patient’s bed reviewing the case, squeezed together trying to hear the discussion while children cried and ran around.  This was a rather large group for rounds, so each case felt extra chaotic. The rooms were filled with five beds to seven beds with mothers and fathers at the bedside, and toys all over.  The healthier children ran around while their mothers chased them and brought them back to their beds.  Nurses moved from patient to patient, checking vitals and so forth. We moved on to the final room where everyone seemed to be especially excited about the final patient. 

 

The medical students and interns were rushing to get to the last room, some of them ran ahead of the rest of the group.  The doctors decided to conduct the presentation next to the patient rather than in the hallway.  I was in the hallway unsure whether to wait for the rest of the group or proceed, when the attending came up to me and said to go inside in an excited fashion.  As I walked in to the room, in the far back corner sat a very concerned father next to a nine year old boy lying still, underneath the waffle print white blankets covering him to his neck.  The space was crowded with nurses squeezing past us, interns crowding the bedside and doctors examining the patient. The nurse had to ask the father to move back to make space for our large groups.  As we gathered around, one of the medical interns began the presentation.  As she spoke, the attending physician pulled back the covers to reveal a circular macular rash covering his body.  Normally, there is a student next to me explaining the case as it is presented but this time all of the students were so focused listening to the presentation that no one stopped to break down the details for me.  I walked over to the resident and asked her what this patient had, but to my surprise she said they didn’t have a diagnosis yet, and were trying to figure it out.  I saw this as the best opportunity to demonstrate the applicability of PEMSoft but the students beat me to it!

 

 

 

(Images of Erythema Multiforme provided by

Dr. Sandra Menendez Hoyso and Dr. Natalia Falcon)

 

 

Everyone was pulling out their phone, searching symptoms and possible diagnoses in the PEMSoft Mobile app  I watched as they looked at images of rashes, which they then compared to the patient then proceed to click on links to other similar conditions or causes of conditions.  I saw them search for “macular rash” then “Erythema Multiforme” followed by “Mycoplasma Pneumonia” which became the differential diagnosis.  I was standing next to one of the doctors using the app and watched as she scrolled through the tabs reading information about Erythema Multiforme and Mycoplasma Pneumonia.  She went back and forth between the “General Information”, “Treatment”, and “Images” tabs.  The resident walked over to me to explain that while they currently did not have a diagnosis for the patient, they were considering Erythema Multiforme with the source being Mycoplasma Pneumonia.  She then smiled and said, “We are all using PEMSoft to come up with the diagnosis.  When we have a patient with something unknown, we use PEMSoft to look up information about possible causes and find the latest treatment”.  

 

 

 

(Images of Erythmea Multiforme on arms and face.  Images provided by Dr. Sandra Menendez Hoyos and Dr. Natalia Falcon)

 

 

 

 

The interns in the room spent the most amount of time using the PEMSoft app and comparing notes with each other.  One intern would search one topic while the other would look up information about another.  The lead physician would examine the patient and ask the interns to look up topics as they came up with ideas.  It was a very exciting, collaborative team effort where PEMSoft served as the platform for the exchange of information and learning of medicine.  They brainstormed and developed a differential diagnosis, then honed in on the most likely diagnosis.  Based on the tentative diagnosis, they implement the treatment recommended in PEMSoft while awaiting results of lab tests. 

 

This was the first time I saw PEMSoft used in every step of a difficult case that had no clear diagnoses.   Each student had at his/her fingertips the tool that allowed the correct diagnosis to be made so the proper treatment could be implemented.  The clarity of the images in PEMSoft, which could be used at bedside and compared to the patient in real-time, saved time and improved learning.  This alone was gratifying, but when I considered that this was happening during the first week that our team was there, I realized what a tremendously powerful tool this was, and the importance of spreading PEMSoft to as many medical students, interns, and residents as possible. 

 

 

 

 

 

 

 

 

 

 

 

 

(Images Medical Students using PEMSoft at the bedside and of Dr. Natalia Falcon examining patient)

 

 

 

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