I work at a fairly small regional hosspital. 2 days ago I was transfered a patient with a rash, and stomatitis. (I work on a stepdown unit currently.) From previous experience on a burn unit, I immediatly recognized the case as Stevens-Johnson. I called the physician and after some debate he confired as did a second doctor.
This patient has a rash covering 50% of her body, bright red and still intact as of tonight. Her lips, mouth, and vagina are currently sloughing. The doctor is still having us nurses try to feed her and give her pills. She is in such pain she has become fairly somulent.
The only skin care being done is Cetaphil lotion QID. Tonight she developed a 4inch blister on her arm which appear as if it might open by morning. She is recieving 120 mg Solumedrol q8. The doctor says, "I am following standard of care." (note: i did not mention anything about IV morphine) only lortab and ms contin which she cannot swallow.
I am very concerned about this patient. She is dying. I cannot get the doctor to consult another doctor who has seen this before or transfer her to the ICU much less another hospital with a burn unit.
Can someone please refer me to somewhere where I can find a standard of care for Stevens-Johnson, so I can take it to the doctor and patient advocate so others know she is not recieving the care she needs.
Mar 28, '04
Here is the e-medicine entry
Here is the Steven-Johnson Syndrome Foundation and it lists physicians who have experience with the disease
Those were the best post me if you want more but basically you are right - treat like a bad bad burn.
Last edit by gwenith on Mar 28, '04