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Silvadene-HELP

Irishgirl specializes in ER, Research.

:uhoh21: I never knew that Silvadene was a sulfa drug!!! I can't believe it...I got burned this a.m. and the nurse said "if you open this stuff in the same room w/ a pt who is allergic to sulfa they'll..." and then she acted like she was dying. I used that stuff on burn pts in the ER for FOUR years, and even though the MD ordered it and, hopefully, checked allergies, I still didn't know. I feel awful. I never saw any of my pts go into anaphylaxis after I applied it, and I never had any reports of pts coming back and c/o allergic reaction to the Silvadene, but I feel like a class A idiot. I thought it was just for the pain of the burn, and to cool the skin until the burn healed. I didn't even know it was an antibiotic cream! Jeez, I'm an IDIOT. Should I worry that I put this stuff on some sulfa sensitive pt or should I let it go? Another RN I worked w/ said she didn't know this either. Has anyone else experienced something similar? Please help me!:uhoh21:

maryloufu specializes in PCU, Home Health.

I think you should learn from this experience and move on. I guess you could beat your head against the wall for a few days if you feel the need to be punished- but you didn't do it on purpose and hopefully all of your patients are ok. I am glad you posted because I didn't realize it was a sulfa drug either.

Thanks.

Silvadene=silver sulfadiazine

to prevent and treat infection in burn wounds

caused by Pseudomonas and many other organisms

(listed under topical antimicrobial agents, and

sulfonamides)

live and learn

Irishgirl specializes in ER, Research.

I didn't look it up until...tonight! I only saw "silvaden" in our Pixus. I feel like a class A idiot. I just pray any pts I put it on are okay, would I have heard if they were really harmed? I never treated anyone w/ it who was admitted, only more minor burns. Nobody else has a "duh" story to share?? Anyone??:uhoh21:

Altra specializes in Emergency & Trauma/Adult ICU.

Allergic reactions run the gamut from "hypersensitivity" (i.e., intolerable diarrhea) to anaphylaxis, with a lot of possibilities in between those two extremes. So I'm not quite following your co-worker's dramatic depiction of harm to a patient "if you open this stuff in the same room ...". Are you saying that you believe particles of the cream become airborne? ??? That all sulfa allergic reactions are anaphylaxis? ???

I am anaphylactically allergic to sulfa. I'll spare you my anaphylaxis tale ... I'm just thankful that at the time I was somewhere where EMS response time was less than 3 minutes. I apply Silvadene creme frequently. I double glove & wear a gown until I've discharged the patient & changed the linens.

sirI specializes in Education, FP, LNC, Forensics, ED, OB.

the nurse said "if you open this stuff in the same room w/ a pt who is allergic to sulfa they'll..." and then she acted like she was dying

Definitely blown out of proportion.

Yes, is a sulfa-derivative. Normally, if used on extensive areas of burned tissue, sulfa can be absorbed in the bloodstream and cause reaction/anapylaxis.

In the situation OP suggests, possibility is rather minimal.

Must be familiar with every drug given patients. Requires self-education and not soley rely on pixis, etc.

Good job, Irishgirl, being concerned and desiring to educate yourself about this.;)

I did not mean to sound harsh at all. Whenever I pull a med out of the Pyxis and look at it to make sure I have the right med, it either has just the generic name on it, or has the generic name under the trade name. If you're checking your meds as you pull them out, you should have seen this.

Rizpah specializes in LTC / SNF / Geriatrics.

I agree with Ginger and marylou - learn from the mistake and move on. This experience will keep you more on your toes to prevent future occurances.

In our LTC facility, when we order creams like silvadine, our pharmacist is usually really quick to point out order / allergy discrepancies.

Roy Fokker specializes in ER/Trauma.

As far as possible - always try and look up unfamiliar drugs!

I agree with the others - live and let learn!

cheers,

Roy

PS: Allergy indexes are somewhat screwy sometimes. I know I've given Toradol to patients claiming allergy to NSAIDs and Vicodin to patients claiming allergy to Codeine.

They've done fine and have continued to do fine.

Sometimes we don't know the "kind" of allergy the patient has (for example, my "Codeine allergy" patient eventually stated that she gets constipated if she takes it. :rolleyes: Some of my Morphine "allergy" patients will fess up that they "threw up" the last time they had some)

Should I worry that I put this stuff on some sulfa sensitive pt or should I let it go?

Let it go! You now know what Silvadene is.

nursemary9 specializes in Psych, Med/Surg, Home Health, Oncology.

Let it Go and LEARN!!!!

Never give ANYTHING, even a topical agent, unless you know what it is!!!

We learn best from our mistakes.

1) You are not going to kill anyone with SSD by opening it in the same room.

2) The worst reaction I've seen/heard of is a rash, (in the pattern of where the cream was at, distinguishing it from an opportunistic skin infection) in which case we switch to gentamycin or bacitracin. I suppose anaphylaxis could occur... but it is still best to screen for sulfa allergies.

Be glad no one was harmed and move on.

We also use silvadene and silvadene based ointments in vet medicine. We are careful to tell our clients that it is a sulfa. Another sulfa drug is lasix. We make sure that they know that it can cause problems too if a person is allergic to it.

Fuzzy

santhony44 specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.

PS: Allergy indexes are somewhat screwy sometimes. I know I've given Toradol to patients claiming allergy to NSAIDs and Vicodin to patients claiming allergy to Codeine.

They've done fine and have continued to do fine.

Sometimes we don't know the "kind" of allergy the patient has (for example, my "Codeine allergy" patient eventually stated that she gets constipated if she takes it. :rolleyes: Some of my Morphine "allergy" patients will fess up that they "threw up" the last time they had some)

I'm in a clinic, and I try to remember to ask patients, particularly new patients, what happened to them when they had the "allergic" reaction to a med.

It is very common for people to report "allergy" when they have a GI upset, yeast infection, or other non-allergic reaction to a drug.

If the patient tells me that they broke out in hives, had lip swelling, or other symptoms of a true allergy, I use that opportunity to reinforce that they never, never, ever take that drug again. I've had people say "that happened years ago, I've wondered if I could take it now" and also known of people who died after trying a drug they were allergic to "just to see what would happen."

I also try to educate the people who think that they are "allergic" to aspirin or codeine or whatever. They might at some point really need that drug.

For example, I had a patient come into a clinic with chest pain. This clinic was 30 miles from the nearest hospital. While my assistant was calling 911,I put oxygen on her. I asked if she were allergic to anything: yes, to aspirin. How did she react to it? "It upsets my stomach." "No rash, no hives, no breathing problems?" "No." "Here, chew this aspirin!" Then she got SL NTG. She had no reaction to the aspirin at all and survived the episode after several days in the hospital.

Patients often don't realize that they are narrowing the clinician's range of therapeutic choices when they say that they are allergic to the erythromycin that gave them diarrhea or the augmentin that leads to a yeast infection.

I know that in a busy ER or hospital floor nurses may not have time to ask those questions but usually I do have the time and find it very enlightening.

I mentioned this on another allergy thread a while back - I am actually allergic to penicillin (broke out in hives the last time I took it), but my NP has noted a second allergy in my chart - ACE inhibitors, specifically lisinopril. I didn't have an allergic reaction, just experienced every unpleasant side effect associated with them. She explained that she would "just list it as an allergy so no one else in her office would decide to prescribe another one to me again." I wondered if statements like that by people's PCPs are why they might report "allergies" to drugs that just cause them discomfort.

I mentioned this on another allergy thread a while back - I am actually allergic to penicillin (broke out in hives the last time I took it), but my NP has noted a second allergy in my chart - ACE inhibitors, specifically lisinopril. I didn't have an allergic reaction, just experienced every unpleasant side effect associated with them. She explained that she would "just list it as an allergy so no one else in her office would decide to prescribe another one to me again." I wondered if statements like that by people's PCPs are why they might report "allergies" to drugs that just cause them discomfort.

Noooo, people who puke after taking codeine or morphine and such honestly think they're allergic to it.

sirI specializes in Education, FP, LNC, Forensics, ED, OB.

She explained that she would "just list it as an allergy so no one else in her office would decide to prescribe another one to me again." I wondered if statements like that by people's PCPs are why they might report "allergies" to drugs that just cause them discomfort.

Yes, quite often.

And, as Tazzi pointed out, too, they truly believe they are allergic to the drug if n/v occurs.

To err on the side of caution is my philosophy.;)

Roy Fokker specializes in ER/Trauma.

Yes, quite often.

And, as Tazzi pointed out, too, they truly believe they are allergic to the drug if n/v occurs.

To err on the side of caution is my philosophy.;)

Totally agree.

But then you're going to end up with the case of my 94 yr old female hip fx admit from nsg home. Allergic to (I kid you not):

anti-emetics

anti-pyretics

analgesics

ß blockers

ACE Inhibitors

Proton Pump Inhibitors

Opioid analgesics

NSAIDs

Penicillins

Sulfa

... and so on and so forth. An allergy list an arm length long! All I could guarantee was that she wasn't "allergic" to Dilaudid and Zofran - because that was all she'd been getting in the ER prior to admit to the floor :uhoh21:

I called up the nsg home and they confirmed the allergy list! My poor, overworked pharmacist was about to pull his hair out...

I mean, when you start listing entire categories for an "allergy", one must have good documentation and reason to back that up, yes?

I know a FF with migraines who is allergic to everything except Demerol and Vistaril. One doc we had wanted me to try O2 and IV Compazine, and suddenly she was magically allergic to Compazine also. I asked her why it wasn't on the list she always carries and she said, "I guess I forgot."

Hmmm...............

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