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Blinking Bug Bite

Mike Weinstock, MD and Matthieu DeClerck, MD
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09:24
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No me gusta!

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Mike and Matt discuss a patient presenting with Quincke’s Pulse  which is a finding associated with aortic insufficiency resulting in focal arterial dilatation. Here, the arterial dilatation in the area of the bite led to an inability of arterioles to maintain sufficient pressure during diastole, resulting in the pulsating blanching and flushing that produced a “blinking” bug bite.

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Lauren L. -

Would the 3 yo patient in this case study necessitate a referral for an echo or referral to cardiology despite normal no audible heart murmur? If patient's present with this sign but the remainder of the exam, including cardiac exam, is normal, is more workup needed?

Mike W., MD -

Good question and the answer is... hard to say (sorry!). One of my main take away points was to consider the possibility of aortic insuff and to make sure a good CV exam is done. If the patient has a normal exam w no murmur, no JVD, no rales, and normal vitals, certainly follow up is important, but an emergent ECHO I would think could be deferred. Follow up would certainly be important! Thx for the question and being a listener --Michael

Scott H., MD -

When I was a family medicine resident in the dark ages, 1986, I saw an otherwise asymptomatic 7 year old caucasian boy brought in for a rash. He had classic appearing target lesions of erythema multiforme BUT they were blinking red white, red white, red white with each heartbeat. You could literally take his pulse by watching his skin. The rest of his history and examination were normal and his family and I got a kick out of the rash as he was blinking like a Christmas tree with widely diffuse lesions. I figured that the tissue pressure in the lesions at the time was above his capillary venous pressure and below his dermal arteriole pressure. Frankly, it was cool and I lamented that fact that I had no video camera as his mother was game for a recording. I have not seen it again since. Fun FYI.

Mike W., MD -

so cool, thx for sharing!!
M

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Urgent Care Rap September 2020 Written Summary 577 KB - PDF

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