Page 92 - Journal of Special Operations Medicine - Spring 2016

An Ongoing Series

Red Rash

Joshua Banting; Tony Meriano, MD

CONCEPTS AND OBJECTIVES
The series objective is to review various clinical con- diagnosed the individual with insect bites, but just
ditions/presentations, including the latest evidence on wanted to get your opinion.
management, and to dispel common myths. In the pro-
cess, core knowledge and management principles are The patient is a 29-year-old female intelligence analyst.
enhanced. A clinical case will be presented. Cases will She looks well and is in no distress. She has no significant
be drawn from real life but phrased in a context that is prior medical illness. She takes oral contraceptives, her
applicable to the Special Operations Forces (SOF) or antimalarial medication is doxycycline, and she has no
tactical emergency medical support (TEMS) environ- allergies. She has never had a rash like this before. She
ment. Details will be presented in such a way that the has remained inside the wire for the entire rotation.
reader can follow along and identify how they would
manage the case clinically depending on their experi- She is alert and in no significant distress. Her heart rate
ence and environment situation. Commentary will be is 86, respiratory rate is 12, oxygen saturation level is
provided by currently serving military medical techni- 98%, and temperature is 37°C. There is a rash on her
cians. The medics and author will draw on their SOF extremities, as depicted in Figures 1 and 2. Upon closer
experience to communicate relevant clinical concepts examination, the rash is nonblanching and is raised
pertinent to different operational environments includ- (palpable). It is minimally tender.
ing SOF and TEMS. Commentary and input from ac-
tive special operations medical technicians will be part
of the feature.
Figure 1 Rash
Keywords: rash; rash, red; dermatology
on patient’s lower
extremities.

Clinical Presentation
You are working in a deployed setting as the senior med-
ical clinician at a small forward operating base. Your
team of about 60 personnel is involved in a training
mission. The environment is semipermissive, but local
medical resources are very limited. You basically have
an i-Stat machine (Abbott Laboratories; https://www
.abbottpointofcare.com), an ultrasound machine, and
your own clinical acumen as resources. Figure 2 Close-up
of rash on patient’s
Your junior medical technician reports that he has been lower extremities.
following a patient with a rash on her feet and ankles. It
has been there for a few days but appears to be spread-
ing. It is slightly tender, but not itchy (pruritic). He had

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