Management = stop offending agent + supportive + possible steroid, IVIG + admit to burn unit if severe (it has similar effects as burns) Mortality risk is 5% (just remember it can be fatal) Called SJS alone if skin loss is seen in <10% of body; if 10 – 30% = SJS + TEN; > 30% involvement = TEN Toxic Epidermal Necrolysis (TEN) SJS (due to drugs), but widespread skin necrosis and sloughing is > 30%; Nikolsky sign positive There is severe mucous membrane involvement High risk of sepsis, dehydration, electrolyte abnormalities High mortality rate (10 30%!!!) – EMERGENCY MEDICINE Normal range (Manal Darwish): For the all the below, expect variations during activity (feeding, crying, etc.), so best measure it when child is relaxed Respiratory rate (RR): Neonate: 40 60 (> 60 = tachypnea) – 1st year: ≤50 1 3 – ≤40 > 3 years: ≤30 Blood pressure (BP): Great variation between sources Neonate: 50/30 1st year: 70/40 1 5 90/50 – > 5 Years gradually increases to become adult value – Heart rate (HR): Newborn: <200 (≥ 200 = sinus tachycardia, 220 = SVT) ≥ Average is around 160 180 – Infancy: < 180 > 1 year old: <140 By 5 years old, approaches adult values (60 100) – Hemoglobin levels (g/dL) Birth: 14 20 g/dL (very important, anything below 14 SHOULD – SCARE YOU) It is mostly MACROCYTES, so the MCV (fL) will be HIGH in newborns (normal) Reticulocyte (%) normal is 1 6 % – – Low RC = < 1%
Management = stop offending agent + supportive + possible steroid, IVIG + admit to burn unit if severe (it has similar effects as burns) Mortality risk is 5% (just remember it can be fatal) Called SJS alone if skin loss is seen in <10% of body; if 10 – 30% = SJS + TEN; > 30% involvement = TEN Toxic Epidermal Necrolysis (TEN) SJS (due to drugs), but widespread skin necrosis and sloughing is > 30%; Nikolsky sign positive There is severe mucous membrane involvement High risk of sepsis, dehydration, electrolyte abnormalities High mortality rate (10 – 30%!!!) EMERGENCY MEDICINE Normal range (Manal Darwish): For the all the below, expect variations during activity (feeding, crying, etc.), so best measure it when child is relaxed Respiratory rate (RR): Neonate: 40 – 60 (> 60 = tachypnea) 1st year: ≤50 1 – 3 ≤40 > 3 years: ≤30 Blood pressure (BP): Great variation between sources Neonate: 50/30 1st year: 70/40 1 – 5 90/50 > 5 Years – gradually increases to become adult value Heart rate (HR): Newborn: <200 (≥ 200 = sinus tachycardia, ≥ 220 = SVT) Average is around 160 – 180 Infancy: < 180 > 1 year old: <140 By 5 years old, approaches adult values (60 – 100) Hemoglobin levels (g/dL) Birth: 14 – 20 g/dL (very important, anything below 14 SHOULD SCARE YOU) It is mostly MACROCYTES, so the MCV (fL) will be HIGH in newborns (normal) Reticulocyte (%) – normal is 1 – 6 % Low RC = < 1%
ENDOCRINOLOGY+RENAL+NEUROLOGY+ONCOLOGY+and+whatever+is+left.docx