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Critical Care in Dermatology
Arun C Inamadar, Aparna Palit
CHAPTER 1:
Dermatological Emergencies: General Considerations
INTRODUCTION AND DEFINITION
DERMATOLOGICAL EMERGENCIES: MAGNITUDE OF THE PROBLEM
CLASSIFICATION
APPROACH TO A PATIENT WITH DERMATOLOGICAL EMERGENCY
History
Physical Examination
Laboratory Evaluation
Skin Biopsy
Prognostic Criteria
Chest X-ray
ACUTE SKIN FAILURE: AN OVERVIEW
Management of Acute Skin Failure
GENERAL PRINCIPLES OF MANAGEMENT OF DERMATOLOGICAL EMERGENCIES
Role of Physician and Pediatrician
Role of Surgeon
Role of Anesthetist
CHAPTER 2:
Dermatological Emergencies
INTRODUCTION
ERYTHRODERMA
PSORIASIS
Psoriatic Erythroderma
Acute Generalized Pustular Psoriasis of von Zumbusch
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid Laboratory Diagnostic Methods
Differential Diagnosis
Management
SEVERE CUTANEOUS ADVERSE DRUG REACTIONS
SJS/SJS-TEN/TEN
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid Laboratory Diagnostic Methods
Differential Diagnosis
Management
Drug Hypersensitivity Syndrome
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid laboratory Diagnostic Methods
Differential Diagnosis
Management
Drug-Induced Urticaria and/or Angioedema
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Differential Diagnosis
Rapid Diagnostic laboratory Method
Management
Serum Sickness
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Differential Diagnosis
Rapid Diagnostic Laboratory Method
Management
ANAPHYLAXIS
VASCULAR DISORDERS
Acute Urticaria and Angioedema
Introduction
Why the Disease is an Emergency?
Clinical Presentation
Clinical Clues
Rapid laboratory Diagnostic Methods
Differential Diagnosis
Management
Purpura Fulminans
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid laboratory Diagnostic Methods
Differential Diagnosis
Management
Antiphospholipid Antibody Syndrome (Hughes Syndrome, Sneddon Syndrome)
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid laboratory Diagnostic Methods
Differential Diagnosis
Management
Calciphylaxis
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid laboratory Diagnostic Methods
Differential Diagnosis
Management
Kawasaki Disease (Mucocutaneous lymph node syndrome)
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid laboratory Diagnostic Methods
Differential Diagnosis
Management
COLLAGEN VASCULAR DISORDERS
Acute Cutaneous lupus erythematosus
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid laboratory Diagnostic Methods
Differential Diagnosis
Management
COMPLICATED VASCULAR TUMORS
A. Kassabach Merritt Syndrome
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid laboratory Diagnostic Methods
Management
Multifocal/Diffuse Neonatal Hemangiomatosis
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid laboratory Diagnostic Methods
Management
VESICULOBULLOUS DISORDERS
Genetic Blistering Disorders
Introduction
Why the Disease is an Emergency?
Clinical Presentation
Clinical Clues
Rapid laboratory diagnostic methods
Differential Diagnosis
Management
Immunobullous Disorder
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid laboratory Diagnostic Methods
Differential Diagnosis
Management
INFECTIONS
Necrotizing Fasciitis
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid laboratory Diagnostic Methods
Differential Diagnosis
Management
Meningococcemia
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid laboratory Diagnostic Methods
Differential Diagnosis
Management
Disseminated Gonococcal Infection
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid laboratory Diagnostic Methods
Differential Diagnosis
Management
Rickettsial Spotted Fever
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid laboratory Diagnostic Methods
Differential Diagnosis
Management
Dengue Hemorrhagic Fever and Dengue Shock Syndrome
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid Laboratory Diagnostic Methods
Differential Diagnosis
Management
BACTERIAL TOXIN MEDIATED ILLNESSES
Staphylococcal Scalded Skin Syndrome
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid Laboratory Diagnostic Methods
Differential Diagnosis
Management
Toxic Shock Syndrome
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid Laboratory Diagnostic Methods
Differential Diagnosis
Management
Scombroid Fish Poisoning
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid Laboratory Diagnostic Methods
Differential Diagnosis
Management
REACTIONS IN LEPROSY
Severe Neuritis with Nerve Abscess/Impending Nerve Palsy
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid Laboratory Diagnostic Methods
Differential Diagnosis
Management
Severe Type 2 Reaction in Leprosy
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid Laboratory Diagnostic Methods
Differential Diagnosis
Management
BITES/STINGS/VENOM
Bite by Insects of Hymenoptera Species (Bees, Wasps, Fire Ants)
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Differential Diagnosis
Management
Spider Bite (Arachnidism)
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Differential Diagnosis
Management
Introduction
Why the Disease is an Emergency?
Clinical Presentation
Clinical Clues
Rapid Laboratory Diagnostic Methods
Differential Diagnosis
Management
Tick Paralysis
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Differential Diagnosis
Management
Envenomation by Jellyfish, Sea Anemones and Coral
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Differential Diagnosis
Management
METABOLIC DISORDERS
Neonatal Biotin Deficiency
Introduction
Why the Disease is an Emergency?
Clinical Presentation
Clinical Clues
Rapid Laboratory Diagnostic Methods
Differential Diagnosis
Management
Acrodermatitis Enteropathica
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid Laboratory Diagnostic Methods
Differential Diagnosis
Management
DRUG-INDUCED CUTANEOUS NECROSIS
Warfarin/Coumarin Necrosis
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid Laboratory Diagnostic Methods
Differential Diagnosis
Management
Heparin-induced Skin Necrosis
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Differential Diagnosis
Management
Tissue Necrosis due to Vasopressors
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Differential Diagnosis
Management
ACUTE GRAFT VERSUS HOST DISEASE
Introduction
Why the Disease is an Emergency?
Population at Risk
Clinical Presentation
Clinical Clues
Rapid Laboratory Diagnostic Methods
Differential Diagnosis
Management
CHAPTER 3:
Fluid, Electrolyte and Nutrition Therapy in Dermatological Emergencies
INTRODUCTION
BODY FLUID COMPARTMENTS
FLUID, ELECTROLYTE DISTURBANCES AND PROTEIN LOSS IN ACUTE SKIN FAILURE
FLUID, ELECTROLYTE AND NUTRITIONAL THERAPY IN DERMATOLOGICAL EMERGENCIES
FLUID RESUSCITATION IN PATIENTS WITH TEN
Assessment of Body Surface Area Involved
Calculation of Replacement Fluid (First 24 Hours)
Calculation of Maintenance Fluid and Ongoing Evaporative Fluid Loss
Choice of Fluid
Route of Administration
Monitoring
FLUID AND ELECTROLYTE THERAPY IN ERYTHRODERMA
NUTRITIONAL SUPPLEMENTATION IN PATIENTS WITH DERMATOLOGICAL EMERGENCIES
CHAPTER 4:
Procedures and Techniques in Dermatological Emergencies
INTRODUCTION
VITAL SIGNS AND MONITORING
Respiratory Rate
Pulse
Blood Pressure
Temperature
UNIVERSAL PRECAUTIONS
PROCEDURES AND MANEUVERS
Vascular ACCESS
Indications
Peripheral Venous Access
Sites for Peripheral Lines
Procedure
Complications
Venesection
Equipments for Venesection
Procedure
Central Venous Catheterization (CVC)
Indications
Sites
Procedure
Complications
Arterial Catheterization
Cannulation Sites
Indications
Procedure
Complications
AIRWAY ACCESS/MAINTENANCE
Introduction
Opening of Airway
Procedure
Monitoring and Care
Endotracheal Intubation
Indications
Equipment
Conventional Orotracheal Intubation
Complications
Nasotracheal Intubation
Nasogastric ACCESS
Transurethral CATHETERIZATION
Cardiopulmonary RESUSCITATION
Basic Life Support
ACKNOWLEDGEMENT
CHAPTER 5:
Diagnostic Procedures in Critical Care Set Up
INTRODUCTION
BLOOD CULTURE
Indications for Blood Culture
Principles of Sample Collection for Blood Culture
Technique of Sample Collection for Blood Culture
PUS SAMPLE COLLECTION
SPECIMEN COLLECTION FROM SKIN
SPECIMEN COLLECTION FROM THROAT AND MOUTH
Technique of Specimen Collection
SPECIMEN COLLECTION FROM RECTUM
BEDSIDE ESTIMATION OF BLEEDING TIME AND CLOTTING TIME
Estimation of Bleeding Time
Estimation of Clotting Time
CHAPTER 6:
Nursing Care in Dermatological Emergencies
INTRODUCTION
SKIN CARE NURSING IN NON-DERMATOLOGICAL CRITICALLY ILL PATIENTS
Pressure Ulcers
Drug Reactions
Perineal Dermatitis
Oral Care Interventions
Eye Care Interventions
NURSING CARE OF THE SKIN IN DERMATOLOGICAL EMERGENCIES
Stevens-Johnson Syndrome–Toxic Epidermal Necrolysis
General Nursing Interventions
Specific Nursing Interventions
Epidermolysis Bullosa
Pemphigus Vulgaris and Other Bullous Dermatoses
Erythroderma
Nursing Interventions
CHAPTER 7:
Dermatology Intensive Care Unit (DICU)
INTRODUCTION
CONCEPT OF INTENSIVE CARE AND INTENSIVE CARE UNIT
Do Patients with Dermatological Illnesses Really Need Intensive Care and Dermatology Intensive Care Unit?
ADMISSION CRITERIA FOR DICU
MULTIDISCIPLINARY APPROACH IN PATIENTS ADMITTED IN DICU
HOW TO SET UP DICU?
INSTRUMENTS AND EQUIPMENTS
EMERGENCY DRUGS
Protocols and Charts
SKILLS TO BE ACQUIRED BY DERMATOLOGISTS
CHAPTER 8:
Drugs Used in Dermatological Emergencies
INTRODUCTION
CLASSIFICATION
Drugs Used to Overcome the Critical Condition of a Patient
Drugs Used for Definitive Treatment of a Dermatological Condition Giving Rise to Dermatological Emergency
ADRENALINE
Indications
Dose
Adults
Children
Adverse Effects
Contraindications
Precaution
Drug Interactions
Prevention of Acute Adverse Effects and their Management
DOPAMINE
Indications
Dose
Adverse Effects
Administration
DOBUTAMINE
FRUSEMIDE
Indications
Dose
Administration
Adverse Effects
Drug Interactions
ATROPINE
Indications
Dose
Contraindication
COLLOIDS AND CRYSTALLOIDS
Crystalloids
Normal Saline (0.9%)
Ringer's Lactate
Dextrose Solutions
Colloids
Dextran
Human Serum Albumin
SODIUM BICARBONATE
Indications
Dose
Drug Interaction
CALCIUM GLUCONATE
Indication
Dose
Adverse Effects
Heparin
OXYGEN THERAPY
CORTICOSTEROIDS
Indications
Corticosteroids Used in Emergency Care
Major Drug Interactions
Dosage Schedule
Adverse Effects
Precaution
Clinical and Laboratory Monitoring
INTRAVENOUS IMMUNOGLOBULIN
Indications in Dermatological Emergency
Contraindications
Adverse Effects of IVIg Therapy and Prevention
Dosage Schedule
Regimen A
Regimen B
CYCLOSPORINE
Indications and Contraindications
Dosage Schedule
Dose Adjustment in Special Situations
Renal Disease
Hepatic Dysfunction
Hyperlipidemic Patients
Clinical and Laboratory Monitoring
METHOTREXATE
Indications
Dose
Adverse Effects
Contraindications
Absolute Contraindications
Relative Contraindications
Patient Monitoring While on MTX Therapy
Baseline, Before Starting Treatment
While the Patient is on Treatment
Drug Interactions
Methotrexate Toxicity
CYCLOPHOSPHAMIDE
Indications
Dose
Adverse Effects
Contraindications
Absolute Contraindications
Relative Contraindications
Patient Monitoring While on Cyclophosphamide Therapy
Management of Cyclophosphamide Toxicity
VINCRISTINE
Recommended Dose
Outcome
CHAPTER 9:
Rescue Therapy in Dermatology
INTRODUCTION
Indications
CYCLOSPORINE AS RESCUE THERAPY
Psoriasis
Atopic Dermatitis
INFLIXIMAB AS RESCUE THERAPY
Generalized Pustular Psoriasis
Kawasaki Disease
CORTICOSTEROID AS RESCUE THERAPY
Kawasaki Disease
RESCUE THERAPY IN METHOTREXATE TOXICITY
General Measures
Antidotes
RESCUE THERAPY IN DAPSONE INDUCED METHEMOGLOBINEMIA
Treatment
RESCUE THERAPY IN CYCLOPHOSPHAMIDE INDUCED BLADDER TOXICITY
OTHER INDICATIONS OF RESCUE THERAPY IN DERMATOLOGY
Immunoablative High Dose Cyclophosphamide
Prevention of Herpes Simplex Mucositis in Bone Marrow Transplant or Stem Cell Transplant Patients
CHAPTER 10:
Dermatological Drug Therapy in Challenging Clinical Scenarios
INTRODUCTION
DERMATOLOGICAL DRUG THERAPY IN PATIENTS WITH RENAL IMPAIRMENT
Renal Drug Clearance
Pharmacokinetic Alterations in Renal Impairment
Dose Adjustment of Drugs in Renal Impairment
Initial Patient Assessment
Assessment of Renal Impairment
Selection of Loading Dose
Selection of Maintenance Dose
Monitoring Outcomes
Drug Dosing in Dialysis
Drug Dosing in Acute Renal Failure
DERMATOLOGICAL DRUG THERAPY IN PATIENTS WITH HEPATIC IMPAIRMENT
Hepatic Drug Clearance
Dosage Adjustment in Patients with Liver Disease
Dosage Adjustment for High Extraction Drugs
Dosage Adjustment for Low Extraction Drugs with Low Binding to Albumin (<90%)
Dosage Adjustment for Low Extraction Drugs with High Binding to Albumin (>90%)
Dosage Adjustment for Intermediate Extraction Drugs
Renal Clearance of Drugs in Patients with Liver Disease
CHAPTER 11:
Drugs in Pregnancy and Lactation
INTRODUCTION
PHYSIOLOGICAL CHANGES IN PREGNANCY AND THEIR EFFECT ON PHARMACOKINETICS
DRUG DOSING IN PREGNANCY
PRENATAL DEVELOPMENT AND RELATIONSHIP WITH MATERNAL DRUG INTAKE
PHARMACOKINETICS OF DRUGS INGESTED BY THE MOTHER IN THE FETUS
DRUG CATEGORIZATION DURING PREGNANCY
DRUG PRESCRIPTION IN LACTATING WOMEN
MONITORING AND MANAGEMENT PRINCIPLES
Appendix
DERMATOLOGIC DRUGS DURING PREGNANCY AND LACTATION
Antihistamines
Antibacterial Agents
Topical Acne Medications During Pregnancy
Topical Antibiotics
Antifungal Agents
Topical
Oral Antifungal Agents
Antivirals in Pregnancy and Lactation
Biologic Agents
Systemic Immunomodulatory and Antiproliferative Agents in Pregnancy and Lactation
Antimalarial Drugs
Corticosteroids in Pregnancy and Lactation
Antiscabetics and Antipediculicides in Pregnancy and Lactation
Topical Immunomodulators in Pregnancy and Lactation
Miscellaneous Drugs
Local Anesthetics
Analgesics
INDEX
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