#ecuimres transcript

Healthcare Social Media Transcript

From: Fri Jan 18 5:00:00 PST 2013
To: Fri Jan 18 7:15:00 PST 2013

What is #ecuimres? Who were the influencers during this time period? #ecuimres analytics


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ecuimchiefs
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Join us #ecuimres this morning for IM #GrandRounds by Dr. Phillips on "Drug Eruptions: An Update".
ecuimchiefs
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#ecuimres #grandrounds #dermatology What does a drug rash look like? Pretty much like anything!
ecuimchiefs
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#ecuimres #grandrounds Indicators of seriousness: look ill? Mucous membrane involve? Confluence, facial edema, angioedema, etc
ecuimchiefs
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#ecuimres #grandrounds Likely meds to cause eruption: ANY. Abx, seizures meds, allopurinol, new meds (usually 4-21 days)
ecuimchiefs
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#ecuimres #grandrounds Need to double check drug allergies! Ie: sulfa or pcn allergies
ecuimchiefs
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#ecuimres #grandrounds Transitioning to management of eruptions: reassure, educate, antihistamines, topical steroids, sometimes prednisone
nephondemand
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#ecuimres @ecuimchiefs Dr Phillips gave a gr8 talk on new derm therapies back in 2011! http://t.co/jiAoz8NW #dermatology #skin #eczema
ecuimchiefs
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#ecuimres #grandrounds If your pt develops a severe reaction, take advantage of the EMR and notate this in the chart ie: allergies
ecuimchiefs
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#ecuimres #grandrounds Most common type of reaction is a morbiliform eruption
ecuimchiefs
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#ecuimres #grandrounds Morbiliform eruptions don't progress to TEN. Will not improve until drug cleared from body. Immune rx will take weeks
ecuimchiefs
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#ecuimres #grandrounds Urticarial drug rash: pruritic wheals
ecuimchiefs
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#ecuimres #grandrounds Outpatient hives usually not drug related.
ecuimchiefs
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#ecuimres #grandrounds Fixed drug eruption related to doxycycline (pt kept getting rash when he'd go to urologist) http://t.co/s1hQF0lc
ecuimchiefs
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#ecuimres #grandrounds Fixed drug eruption: every time pt is exposed to a certain med develop localized eruption
ecuimchiefs
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#ecuimres #grandrounds Acral Eythema more common in pts receiving chemotheraoy
ecuimchiefs
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#ecuimres #grandrounds Coumadin necrosis: Develops 3-5 days after initiation. Women more commonly affected. Typically can keep warfarin.
ecuimchiefs
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#ecuimres #grandrounds Levamisole in cocaine being recognized more and more leading to vasculopathies.
ecuimchiefs
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#ecuimres #grandrounds Eval for vasculitiis: biopsy not necessary. Consider checking urinalysis for red cells and chemistry
ecuimchiefs
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#ecuimres #grandrounds Depending on severity, pt may need steroids (ie: image on left). Discontinue offending drug. http://t.co/mqzcWoqO
ecuimchiefs
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#ecuimres #grandrounds Dr Phillips' 'cracker test' for TEN. If pt suspected of TEN can eat crackers, it's NOT TEN!
ecuimchiefs
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#ecuimres #grandrounds 40 yo F with new rash (image) xfew months. Epidermolysis bullosa assoc w/ penicillamine therapy http://t.co/cvVLh0VJ
ecuimchiefs
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#ecuimres #grandrounds Erythema multiforme-StevensJohnsonSyndrome-ToxicEpidermalNecrolysis spectrum (image) http://t.co/reeJhDFI
ecuimchiefs
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#ecuimres #grandrounds Drugs are incriminated in ~95% of pts with TEN (50% in SJS)
ecuimchiefs
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#ecuimres #grandrounds Target lesions on skin point towards erythema multiforme (EM), but if mucosal involvement ->SJS http://t.co/NHgzNY4x
ecuimchiefs
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#ecuimres #grandrounds Nikolsky sign: http://t.co/REh4mJp1
ecuimchiefs
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#ecuimres #grandrounds Severity of Illness Score for TEN: http://t.co/OOvsU22Q
ecuimchiefs
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#ecuimres #grandrounds Severe ocular involvement in TEN/SJS can lead to scarring and loss of vision.
ecuimchiefs
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#ecuimres #grandrounds Time course for TEN/SJS: 10-14 days after initial exposure, 2-4 days prodrome prior to eruption.
ecuimchiefs
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#ecuimres #grandrounds Mgmt for TEN: stop inciting meds, tx to burn unit, fluid support, etc.
ecuimchiefs
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#ecuimres #grandrounds Drug related syndromes: many names for same, but Dr Phillips prefers DRESS (Drug rel eosinophilia and systemic sympt)
ecuimchiefs
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#ecuimres #grandrounds Anti-epileptics commonly incriminated in DRESS reactions.
ecuimchiefs
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#ecuimres #grandrounds Questions??

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