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Stevens-Johnson syndrome and toxic epidermal necrolysis

3/27/2024

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Stevens-Johnson syndrome and toxic epidermal necrolysis

Stevens-Johnson syndrome and toxic epidermal necrolysis are severe cutaneous hypersensitivity reactions.
In SJS, there is typically between 1 to 10% of skin detachment.
When skin detachment ranges between 10 to 30%, it is considered an overlap between SJS and TEN.
TEN is characterized by more than 30% skin detachment.
Drugs, especially sulfa drugs, antiseizure drugs, and antibiotics, are the most common causes.

SJS and TEN typically begin with a prodrome of fever, malaise, and headache. A rash then develops, most commonly on the face, upper torso, palms, and soles. The rash initially resembles target lesions, but it soon coalesces into large blisters. Nikolsky's sign, which refers to the easy detachment of the epidermis upon slight pressure, is a distinctive feature. The mucous membranes of the eyes, mouth, genitals, respiratory tract, gastrointestinal tract, and kidneys are frequently affected, leading to potential complications such as pneumonia or kidney failure.
Diagnosis of SJS and TEN is primarily clinical, but a skin biopsy confirms the diagnosis, showing the detachment of the epidermis and apoptosis of keratinocytes. Differential diagnoses include viral exanthems, drug rashes, toxic shock syndrome, staphylococcal scalded skin syndrome, and erythema multiforme.
While SJS affects a smaller area of the skin, TEN involves a more extensive loss of skin, resembling a severe burn and posing a higher risk of mortality. Treatment for both SJS and TEN involves hospitalization, discontinuation of suspected drugs, and intensive supportive care in specialized units like burn centers or intensive care units

Treatment is supportive care; cyclosporine, plasmapheresis or IV immune globulin, early corticosteroid therapy, and tumor necrosis factor-alpha inhibitors have been used. Mortality can be as high as 7.5% in children and 20 to 25% in adults but tends to be lower with early treatment.

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Emergency and Critical Care Blogs

3/27/2024

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TOP 5 Emergency and Critical Care Blogs:

1. Academic Life in EM
■ Website：aliem.com

2. EM Cases
■ Website：emergencymedicinecases.com

3. Life in the Fast Lane
■ Website：litfl.com

4. EMCrit
■ Website：emcrit.org

5. REBEL EM
■ Website：rebelem.com

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High-Quality CPR (ACLS)

3/5/2024

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High-quality CPR involves considering the following factors:

1. Chest compression fraction.
2. Compression rate.
3. Compression depth.
4. Tidal volume.
5. Chest recoil between compressions.

These elements are essential for high-quality CPR and improving the chances of survival and neurological outcomes in cardiac arrest victims.

Maintain Chest compression fraction above 80%.
Maintain chest compression rate between 100-120 bpm.
Maintain chest compression depth of at least 5 centimeter in adults and at least 1/3 the AP dimension of the chest in infants and children.
Avoid excessive ventilation.

Allow complete chest recoil between compressions to increase venous return to the heart.

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Primary Survey (ABCDE of ATLS)

3/5/2024

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Primary Survey (ABCDE of ATLS):

ATLS is a systematic approach for the assessment of multidisciplinary trauma care.
The primary survey of trauma care focuses on identifying critical conditions by following the A-B-C-D-E sequence:
A. Airway. Ensuring airway patency and protecting the cervical spine.
B. Breathing. Assessing breathing and excluding tension pneumothorax.
C. Circulation. Evaluating circulation and stop bleeding.
D. Disability. Check Glasgow coma score (GCS), muscle power, and pupils.

E. Exposure. Undress (exposure) the patient to check for wounds and keep the patient warm (environmental control).

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Chain of Survival (ACLS)

3/5/2024

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The 6 links in the adult out-of-hospital Chain of Survival are:

Recognition of cardiac arrest and activation of the emergency response system (calling 9-1-1 in the US).
Early CPR with an emphasis on chest compressions.
Rapid defibrillation.
Advanced resuscitation by Emergency Medical Services and other healthcare providers.
Post-cardiac arrest care.
Recovery (including additional treatment, observation, rehabilitation, and psychological support).

A strong Chain of Survival can improve chances of survival and recovery for victims of cardiac arrest.

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Stevens-Johnson syndrome and toxic epidermal necrolysis

Emergency and Critical Care Blogs

High-Quality CPR (ACLS)

Primary Survey (ABCDE of ATLS)

Chain of Survival (ACLS)

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