First Things First (assess & treat for the following)

• Does pt have respiratory problems that require emergent attention?
  • Non-intubated pt seeking the "tripod" position
  • Stridor, hoarseness, drooling, difficulty swallowing
  • Tachypnea, labored respiration
  • Acidosis, hypoxia, relative hypercarbia
  • Wheezing, decreased breath sounds, shortness of breath
• Does pt have evidence of circulatory shock?
  • Systolic BP < 90 mmHg, heart rate >100/min
  • Mottled skin, delayed capillary fill, weak pulses
  • Altered mental status, seizures
• Does pt have new skin findings?
  • Angioedema of tongue, uvula, face (lips, periorbital) or neck
  • Urticaria anywhere on body
• Does pt have new GI complaints such as nausea, vomiting, abdominal pain or diarrhea?

Contact dermatitis: inflammation of skin by agent(s).

• Two major classes:
  • Irritant contact dermatitis such as concentrated acid or base
    • Common irritants in ICU: soaps, detergents, chronic wetness
    • Time of onset: immediately after exposure
    • Location: typically limited to directly exposed areas
    • Appearance: erythema, edema, vesicles & ulcers
  • Allergic contact dermatitis:
    • Common cause is plant exposure (poison ivy); others include preservatives in topical meds, nickel sulfate, formaldehyde, many others possible.
    • Time of onset: often 24-72 hrs after exposure (requires prior sensitization)
    • Location: areas exposed to direct contact
    • Appearance: linear w/ erythema & vesicles (often w/ intense itching)