Sloughing Skin and SOB

[Eydawn]

I also recognized it without Google. What Kaisu said. Although, I will say it would have been nice for Bushy with the "DING!" jeopardy moment to go into what it is, how it occurs, prognosis, etc.

Once you've had to read up on it once, it rings a bell when you see it again. I had to research it in my microbiology class as an adverse reaction to certain antibiotic therapies.

Wendy

CO EMT-B

[BushyFromOz]

I also recognized it without Google. What Kaisu said. Although, I will say it would have been nice for Bushy with the "DING!" jeopardy moment to go into what it is, how it occurs, prognosis, etc.

Once you've had to read up on it once, it rings a bell when you see it again. I had to research it in my microbiology class as an adverse reaction to certain antibiotic therapies.

Wendy

CO EMT-B

I did, i have this great ability to make my entire post dissapear from the editing screen and i cant get it back? If i can ill write a bit of a blurb on it sometime today and whack it up here.

Truth is, i recognised it because i saw it when i had only been in the job for a few weeks ind i mismanaged it as meningococcal

[DartmouthDave]

Hello,

Since the cat is out of the bag I guess we can discuss some of the finer points of management of this syndome.

According to Up to Date:

Stevens-Johnson syndrome — SJS is the less severe condition, in which skin sloughing is limited to less than 10 percent of the body surface [1]. It is characterized by a prodrome of malaise and fever, followed by the rapid onset of erythematous or purpuric macules and plaques [1,2]. The skin lesions progress to epidermal necrosis and sloughing (picture 1A-. Mucosal membranes are affected in 92 to 100 percent of patients, usually at two or more distinct sites (ocular, oral, and genital) [3].

Whereas,

Toxic epidermal necrolysis — Toxic epidermal necrolysis (TEN), or Lyell's syndrome, involves sloughing of greater than 30 percent of the body surface area [1]. TEN also begins with a prodrome of fever and malaise, although temperatures are typically higher than those seen with SJS, often exceeding 39 degrees Celsius. Mucous membranes are involved in nearly all cases [4]. The skin lesions are widely distributed erythematous macules and patches, although about 50 percent of cases begin with diffuse erythema [1,5,6]. In the early stages, skin pain may be prominent and out of proportion to clinical findings [7]. The skin lesions progress to full-thickness epidermal necrosis leads. The ultimate appearance of the skin has been likened to that of extensive thermal injury (picture 2A- [5].

In effect, TEN is repersents worsening SJS. Also, as noted by CM (if I recall correctly) SJS/TEN can effect various body systems. In this case, the patient's lungs are effected. See below:

•Pulmonary - Pulmonary complications of TEN may include dyspnea, hypoxia, bronchial hypersecretion, tracheobronchitis, pulmonary edema, bacterial pneumonitis, and bronchiolitis obliterans [41,42] (a.k.a. B.O.O.P)

This fellow is barley holding his own. He is tired and in a great deal of pain. The lesions cover about 20-30% of his body. Resp are in the 30's and his SpO2 is 86% and refractory to high flow O2 (creeps up to 87-88%). There are course crackes all lobes and the patient is having a great deal of trouble with his inspiratory phase (having trouble expanding his lungs).

His VS are as follows:

GCS 15/15 Anxious

BP 180/100

HR 130

SpO2 87% on 15 lpm

IVx2 is started.

[DartmouthDave]

Call the funeral home?

Seriosly though:

ABC's

Condition of house

What does the patient look like other than posted --->Working hard to breath / The patient is having trouble getting the air in / In effect quite toxic

Any foreign substances in the room such as cleaning supplies or strange smells? -->No

This disease also has a 1970's ring to it. Remember the reports of kids and young women with Toxic Shock Syndrome?--> See below please

This is a very very bad disease. Without intensive care unit help as well as Infectious disease consults and treatment he's gonna die.

I took care of a 18 year old with Toxic Shock about 5 years ago. She died. She was one of the sickest people I've ever taken care of.

This guy needs a University level hospital with all the bells and whistles.

I do not wish this disease on anyone.

RIP Manute (sic)

Hello,

From my understand and research on this topic (for what it is worth) TSS is a DDX of SJS. The rash from TSS is described as 'red lobser-like' in appearance. Whereas, with SJS/TEN the lesion rupture. Pre-hospital care, in general, for TEN, SJS, and TEN is supportive in nature.

We had a TSS here in our ICU ago a year ago. She was one of the sickest people I have seem in awhile. We knew she was septic but the cause was a mystery until an nurse note a tampon during a bath. This was on day 3 of her admission!!

Cheers