Recent News and Articles on the Keywords: emergencies + 0.19 + web  Related to the article below (Last Update: 8/5/2008)

Richard Aster Jr Buys Cooper Industries Ltd., Covidien Ltd ... GuruFocus.com, TX - The impact to his portfolio due to this sale was -0.19%. Richard Aster Jr still held 640733 shares as of 06/30/2008. CBRL Group Inc. is a holding company ...CEPH - AEO - SCUR Stocks Mostly Lower BusinessWeek - Jul 31, 2008 In Paris, the CAC 40 lost 0.19% to 4392.36, while Germany's DAX index dropped 0.3% to 6479.56. In Asia, Japan's Nikkei 225 rose 0.07% to 13376.81, ...XOM Times Online - Auckland Hong Kong shares close off highs ahead of US data; Orient Overseas ... Forbes, NY - Jul 31, 2008 The financial sector index was up 66.85 points or 0.19 pct at 35263.61. Hong Kong Exchanges was down 0.20 hkd or 0.17 pct at 116.30 amid worries over the ... Hong Kong shares end morning higher on US lead; CNOOC, China COSCO ... Forbes all 235 news articles »  HKG:0316 - SHA:601919 Ethnicity and quality of antipsychotic prescribing among in ... British Journal of Psychiatry (subscription), UK - Jul 31, 2008 High-dose antipsychotics were prescribed to 15.1% of White and 11.7% of Black patients (adjusted odds ratio (OR)=0.5, 95% CI 0.19?1.33), and antipsychotic ... BLOTTER: Police reports published July 29 Niagara Gazette, NY - Jul 28, 2008 Drew failed several field sobriety tests and registered a 0.19 percent blood alcohol content on a breath test. She was held in lieu of $750 bail and is due ... Select another date Seeking Alpha, NY - Jul 25, 2008 11:52 AM Short positions in all 19 financial companies covered by emergency SEC rule fell 85% since July 14. Fannie/Freddie down 98%. ... Tokyo shares close firmer on Wall St gains, but capped by caution ... Forbes, NY - Jul 28, 2008 In US trading on Friday, the Dow Jones industrial average rose 21.41, or 0.19 percent, to 11370.69. The Dow, which fluctuated at times Friday, ...SNE - MC Forex embrace Bush, Bernanke and Paulson! OANDA Forex Blog, Canada - Jul 31, 2008 The commodity currencies are stronger this morning, CAD +0.17% and AUD +0.19%. The loonie has extended its recent decline after government reports yesterday ... KSE index slips 1.1 percent as profit taking nips 2-day rebound Arab Times, Kuwait - Jul 14, 2008 Muscat Securities edged 0.19 percent to 11768.95 points. The benchmark has rallied 28.21 percent this year, the best performer in the region. ...KUW:KFIN - KUW:CBK

Dermatologic Emergencies

Introduction

Most skin conditions are not emergencies, but the condition of a person’s skin can be an indication of their overall health. For example, severely dry skin can be indicative of internal diseases such as thyroid disease. Severely itchy skin can be associated with liver disease, thyroid disease, kidney disease, and rarely, internal cancers. In addition, hair loss can be associated with other medical conditions such as severe stress, thyroid disease, anemia, drug reactions, or poor nutrition. Any persistent skin condition should be evaluated by a dermatologist.

The following is an example of a true dermatologic emergency:
 

Case Study

It was the morning of January 1, 1996 when my beeper suddenly went off. It was the emergency room. I was being called for a stat dermatology consult. While most dermatology consults are not considered emergencies, this one certainly was.

By the time I had reached the emergency room, the patient, a 35-year-old woman who had been on medication for arthritis, had begun to develop severe swelling around her eyes, mouth, and nose. In addition, a small blister had developed on her left thumb. A skin biopsy of the blister was performed immediately, and the pathologist on call was summoned to the emergency room. She and I evaluated the biopsy and my deepest fears were realized. This patient had developed a skin condition called toxic epidermal necrolysis (also known as TEN). This condition is the most serious type of drug reaction.

The patient was placed on sterile sheets and hooked up to a cardiac monitor. Her blood was drawn every two hours in order to make sure that she was not becoming dehydrated. A burn unit in Manhattan was notified and the patient was prepared for transfer. By the time she was ready to leave for the burn unit, large blisters had developed on her back, chest, face, and hands. This had occurred within a matter of hours.

The next day, I had contacted the burn unit in order to find out how my patient was doing. I was told that she had lost approximately 87 percent of her skin and that she was expected to remain in the unit for several months. As it turned out, she stayed in the burn unit for total of five months. Happily, however, she has made a full recovery with no long-lasting effects.

Physicians like to joke that there is no such thing as a dermatologic emergency. For the most part, they are correct. However, as you can see by the above example, dermatologic emergencies do in fact exist.
 

Blistering Skin Disorders

Although most blistering skin disorders (such as poison ivy) are not life threatening, some blistering skin diseases, like the above example, represent true dermatologic emergencies.

Sunburn
Sunburn can constitute a dermatologic emergency. Sunburn usually presents as red, inflamed skin. Typically, the redness begins approximately three to four hours after exposure to the sun and can continue to intensify for up to twelve hours after exposure. Most cases of sunburn can be managed at home with a combination of cool compresses and prescription medications, such as topical steroid creams. When sunburn is very severe, it leads to the formation of large blisters. In this case, treatment at a burn unit may be necessary until the skin completely heals. This treatment may involve sterile dressings, intravenous fluid replacement, and occasionally systemic antibiotics (antibiotic medications that travel throughout the body, usually administered in pill or intravenous form).

Pemphigus vulgaris
Pemphigus vulgaris is another example of a blistering disease that requires immediate medical attention. Pemphigus tends to occur in younger patients, people in their 20s, 30s, and 40s. This condition is not the result of a drug allergy. It usually, but not always, starts as a severe inflammation involving the mouth. As the disease progresses, blisters begin to develop all over the body. It must be diagnosed immediately and treated with high-dose oral steroids such as prednisone. Otherwise, the disease is often fatal.

While some blistering diseases may present with the most serious outcomes, they are not the only skin conditions that may represent dermatologic emergencies. I would like to briefly discuss other skin conditions that can be quite serious.
 

Skin Infections

Most skin infections are superficial and not life-threatening. They are easily treated with topical or oral antibiotics.

Cellulitis
However, a condition known as cellulitis can become very serious. Cellulitis is a deep skin infection caused by bacteria, and is most common in people with immunosuppressive diseases such as diabetes. When a person develops cellulitis, the skin becomes red, inflamed, and very warm to the touch. These topical symptoms are sometimes accompanied by generalized (systemic) symptoms such as fever and chills.

Treatment: It is imperative that cellulitis be treated with systemic antibiotics. Oral antibiotics will often be enough. If oral antibiotics are not effective, intravenous antibiotics, administered in the hospital, must be used. If cellulitis goes untreated, a severe life-threatening infection may occur, including something called necrotizing faciitis.

Treatment: In both cases, the patients were treated with intravenous antibiotics and surgical removal of the infected tissue had to be performed. If this type of infection does not receive immediate care, the chances of the patient dying are very high.

Hives

Hives (also known as urticaria) is a skin condition that appears as red, very itchy, bumps. These bumps often disappear within 24 hours only to be replaced by new ones. Hives, like most skin conditions, can be made worse if accompanied by emotional stress. The most common cause of hives is food allergy. However, hives can also be caused by an allergy to medication or by other allergenic factors. It is estimated that one in five people will have hives at some point in their lives.

In addition, hives that persist can sometimes be an indication of other medical problems such as liver disease, thyroid disease, or connective tissue diseases such as lupus. If you develop hives that do not go away, you should be evaluated for other medical problems.

Hives, for the most part, are not life-threatening. However, if swelling develops around the mouth, the condition may also begin to involve the throat. This, in turn, may lead to serious problems with breathing. When this happens, you must go immediately to an emergency room for treatment.

Treatment of hives
Hives should be treated with systemic medications. Initially, oral antihistamines such as Benadryl, can be used. If this is not effective, oral prednisone (a steroid medication) may be required. In very severe cases, where breathing may be compromised, injected, intra-muscular epinephrine (also called adrenaline, a potent steroid medication that increases the heart rate, constricts blood vessels, and opens up airways) may be needed. This, of course, must be administered in the emergency room.
 

Drug Reactions

Drug reactions usually appear as rashes involving all or part of the body. While most drug reactions occur within two weeks of starting the drug, it is important to remember that any medication can cause a reaction in anyone, at any time, while they are taking a drug. Most drug rashes are benign (not harmful), do not represent a serious condition, and go away when the offending medication is stopped.

Stevens-Johnson syndrome: However, if you are allergic to a medication, and you continue to take that medication, a serious drug reaction called Stevens-Johnson syndrome may develop. In this syndrome, in addition to the skin rash, the lining of the nose, mouth, and eyelids become inflamed. This condition can be life-threatening and the offending drug must be stopped immediately. If the drug is not stopped, toxic epidermal necrolysis (TEN), the condition described previously, may result.
 

Summary

While most skin lesions are not emergencies, as we discussed above, there are a few conditions that require rapid medical attention. If you have a skin lesion that is rapidly changing or is accompanied by systemic symptoms such as fever or chills, you should contact your physician. He or she will either be able to address your problem directly or refer you to an appropriate expert.