Steven Johnson Syndrome

  1. I was just wondering what everyones experience was with this syndrome. Although I no longer work in burns in the time I was there we had 7 caasses in one year!!!

    It seemed to me that we could NOT achieve good pain relief no matter what we did. We were, however using Silver Nitrate as a wound dressing.
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    About gwenith

    Joined: Jul '02; Posts: 10,262; Likes: 234
    icu nurse


  3. by   mags-rn
    I no longer work in burns either, but over the past couple of years, there has been an increase in SJS and TENS. I believe it was/has been related to the increased combination of medications used to successfully treat HIV. The main culprits are medications based with sulfa like Dilantin and Bactrim. Pain management is important, so most of our patients were managed on continuous morphine drips. Also, Biobrane or any similar type of bio-synthetic dressing was successful in wound healing and pain management as those dressings remained intact for about 7 days, long enough for superficial injuries to heal. Silver nitrate may be great, but I like to see those patients placed on homograft and iobrane. Daily dressing changes is concerning.
  4. by   gwenith
    Thank-you Mags - the hospital I was working at (note the WAS) insisted on silver nitrate irrigations and being a fan of much of the newer technology I was concerned. Although we started these patients on morphine they would change them over at some stage and I just felt that the whole procedure at this hospital could have done with a good outside review. Mind you the same hospital was doind 2nd hourly cleansing of facial burns.
  5. by   mags-rn
    Steven Johnsons and TENS tend to be partial thickness wounds and really dont require all those extensive and disruptive dressing
    changes. I forgot to mention, we started using ACTICOAT! This was excellent! It is a silver coated barrier and the dressings only
    needed to be changed daily if that often. The barriers could be
    reused up to about 7 days. It really is bothersome that some medical staff do not dialogue with sales representatives who can offer more current wound care products!!
  6. by   clgmezzo
    We also use acticoat sometimes, though most of our docs seem to like xeroform and xeroflo. Also i noted a lot of cases seem to be from a new ADHD drug
  7. by   cimersrn
    Just discharged a SJS pt that none of us thought could possibly make it!!! What a wonderful feeling! Anyway, in our unit we've been using acticoat or a similar product, "silverlon." These are terrific for many reasons, not the least of which is the fact that they eliminate the need for those painful daily or q shift drsg changes. Just need to moisten with sterile H2O prn. The antimicrobial properties of these products is another plus. Just make sure you don't use saline as this will neutralize the silver, thus negating the antimicrobial action. As far as pain relief is concerned, in our unit these pts are usually on Fentanyl and Versed gtts. Hope this helps!
    Last edit by cimersrn on Mar 15, '04
  8. by   clgmezzo
    I just discharged another SJS, this one was for prilosec, believe our gent was onlly the second reported case with this drug . .
  9. by   cimersrn
    We just admitted another SJS pt this past week, believed to be related to the use of a sulfa drug. Sulfa drugs seem to be a relatively common culprit
  10. by   clgmezzo
    The silverlon is a nice product, but i always cringe when i rinse it out and put it back on, just bugs me slightly since everything else is SO sterile, you know? But i do like it otherwise
  11. by   cimersrn
    EWWWWW! We don't "re-use" silverlon. Is this recommended by the manufacturer?
  12. by   clgmezzo
    yeh, the reps couldnt understand why we had a problem with it, rinse in a sterile basin in sterile water, not saline of course, and REAPPLY!! we havent been using as much since we all think thats nasty
  13. by   Mimi2RN
    Quote from clgmezzo
    I just discharged another SJS, this one was for prilosec, believe our gent was onlly the second reported case with this drug . .
    The husband of a woman I know must have had this, they didn't put a name to it, but he was deathly ill, unrecognisable in his photos, and it was r/t Prilosec. Next time I see her, I'll ask if she knows the name of it.

    He is fine, now.
  14. by   dawngloves
    ADHD drugs?? Prilosec?! This blows my mind! The short time I did Burn I saw two cases of TENS. One from Gent and the other from Dilantin. Both expired.