Derm Emergencies

Burns

Types:

  • Thermal: Caused by contact with hot objects, scalding liquids, steam, or open flames
  • Radiation: Resulting from exposure to UV rays (e.g., sunburn) or radiation (e.g., x-rays)
  • Chemical: Due to exposure to acids, alkalis, detergents, or solvents
  • Electrical: From contact with alternating (AC) or direct (DC) current

Burn Classifications:

  • First-degree: Affects only the outer layer (epidermis). Red, no blisters
  • Second-degree: Partial thickness, impacting the epidermis and part of the dermis. Blisters present
  • Third-degree: Full thickness, damaging both the epidermis and dermis
  • Fourth-degree: Extends beyond the skin, affecting muscles, tendons, or bones

Key Points:

  • Understand the Rule of 9s for estimating burn surface area
  • Parkland Formula for fluid resuscitation: 2-4 mL x kg x TBSA. Administer half within the first 8 hours and the remainder over the following 16 hours

Scabies

  • Caused by Sarcoptes scabiei infestation.
  • Severe itching, especially at night, from the neck down.
  • Red, excoriated papules across the body; pink, intensely itchy nodules in the genital area.
  • Burrow sites: fingers, web spaces, wrists, areolae, umbilicus, axillae, elbows, ankles, feet, toes, and toe webs.

Treatment:
Nail care: Keep nails short.
Topical: Apply Permethrin 5% cream from neck down, leave for 8 hours, then rinse. Repeat after 1 week.
Oral: Ivermectin 0.2 mg/kg, with a second dose in 2 weeks.
Environmental cleaning:

  • Wash linens, clothes, and towels.
  • Vacuum sofas, car seats, and chairs.
  • Clean personal items like bags and shoes.
  • Seal non-washable items in plastic bags for 1 week.

Electrolyte Imbalances

Calcium

Low Calcium (Hypocalcemia)

  • Uncommon, often linked to parathyroid issues, blood transfusions, sepsis, or rapid breathing
  • Symptoms: Tingling around the mouth or in hands, muscle cramps, heightened reflexes, seizures, muscle spasms
  • Trousseau’s Sign: Hand spasms when a blood pressure cuff is inflated on the arm
  • Treatment:
    • Acute: Address underlying cause, administer calcium gluconate over 10-15 minutes, consider calcifediol
    • Chronic: Supplement with ergocalciferol, vitamin D, and oral calcium

High Calcium (Hypercalcemia)

  • Causes: Cancer, thiazide diuretics, adrenal insufficiency, kidney failure
  • Symptoms: Nausea, constipation, shortened QT and ST intervals on ECG, abnormal heart rhythms, potential cardiac arrest
  • Treatment:
    • Administer normal saline to dilute calcium levels
    • Use furosemide (Lasix) to avoid fluid overload

Magnesium

Low Magnesium (Hypomagnesemia)

  • Causes: Inadequate dietary intake, alcohol use, poor absorption, gastrointestinal losses
  • Symptoms: Overactive reflexes, muscle cramps, confusion
  • ECG Changes: Supraventricular tachycardia (SVT), prolonged PR and QT intervals, ventricular tachycardia, ventricular fibrillation, torsades de pointes

High Magnesium (Hypermagnesemia)

  • Causes: Excess fluid loss, kidney failure, antacid overuse, adrenal insufficiency
  • Symptoms by Severity:
    • Mild: Reduced deep tendon reflexes, low blood pressure
    • Moderate: Prolonged PR, QT, and QRS intervals on ECG, loss of reflexes
    • Severe: Complete heart block, respiratory muscle paralysis
  • Treatment:
    • Administer intravenous fluids to promote excretion
    • 10% calcium chloride over 30 seconds to stabilize cardiac membrane
    • Dialysis if severe or refractory

Potassium

Low Potassium (Hypokalemia)

  • Causes: Excessive urination, gastrointestinal losses, insulin administration
  • Symptoms: Fatigue, muscle cramps or weakness, flattened T-waves on ECG, rapid heart rate
  • Treatment Notes:
    • Potassium replacement should not exceed 40 mEq/L in IV fluids
    • Continuous cardiac monitoring is recommended

High Potassium (Hyperkalemia)

  • Causes: Insulin deficiency, traumatic injury, burns, acidosis, kidney dysfunction
  • Symptoms: Nervousness, tingling sensations, muscle cramps, peaked T-waves, widened QRS and PR intervals, ventricular fibrillation

Sodium

Low Sodium (Hyponatremia)

  • Manage with hypertonic IV solutions administered via infusion pump with extreme caution
  • Precautions:
    • Seizure precautions should be in place
    • Continuous cardiac monitoring is advised

Euvolemic Hyponatremia

  • Normal sodium levels but increased total body water
  • Often linked to hypothyroidism, which impairs the kidney’s ability to dilute urine
  • Exact underlying mechanism remains unclear

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