424.An 18-year-old man presents to the ED with right leg pain and swelling
after swimming at a local beach. He reports swimming in the ocean, whereupon
he felt a sharp sting in his right leg. Upon physical examination,there is no
gross deformity of the right lower extremity and there is a palpable dorsalis pedis
and posterior tibial pulse. There is tenderness to palpation overthe lateralcalf
with many punctuate, erythematous lesions as seen below. Which of the fol-
lowing is the most appropriate treatment of choice for this patient?
464 Emergency Medicine
(Courtesy of Corey Long, MD.)a. Fresh water
b. Vegetable oil
c. Vinegar
d. Toothpaste
e. Household window cleaner
425.A 49-year-old man presents to the ED with pain, erythema, and
swelling to his left forearm after a chemical spill sustained at work. He irri-
gated the area with water and applied a cold packet before arriving but states
that the burning sensation in his arm is now worse. The patient works in a
glass factory and reports using a rust-removing agent. What tissue-saving
treatment must be administered emergently?
a. Limb tourniquet
b. Calcium gluconate
c. Alkalinization of urine
d. Silver sulfadiazine ointment
e. Surgical debridement