Emergency Department Care For the emergency physician, the two most important elements in the treatment of TEN are discontinuation of the offending drug and admission to a burn unit.[31] Evidence suggests that rapid institution of these two measures is associated with a more favorable prognosis.[32, 33] Emergency department care should be directed toward the following: Maintaining fluid and electrolyte homeostasis Mitigating temperature loss Providing adequate analgesia Preventing secondary infection Aggressive fluid and electrolyte management, pain control, and meticulous skin care are important. Fluid resuscitation with crystalloids should follow standard guidelines used for burn patients. However, patients with TEN typically require less aggressive fluid replacement than that of burn patients because of less severe microvascular injury. A goal of resuscitation should be to maintain sufficient mean arterial blood pressure (ABP >65 mm Hg), central venous pressure (CVP 8-12 mm Hg), and central oxygenation (Svco2 >70%) for adequate tissue perfusion and renal perfusion.[21] Fluid management should be based on the physiologic endpoint of urine output of 0.5-1 mL/kg/h.[31] Patients with extensive skin involvement require reverse isolation and a sterile environment. Areas of skin erosion should be covered with nonadherent protective dressings such as petrolatum gauze. Respiratory distress may result from mucosal sloughing and edema and may necessitate endotracheal intubation and ventilation.
Posted on: Fri, 28 Jun 2013 09:58:30 +0000
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