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ARTICLE:
Marcus Spies, Arthur P. Sanford, J. F. Aili Low, Steven E. Wolf, and David N. Herndon
Treatment of Extensive Toxic Epidermal Necrolysis in Children
Pediatrics 2001; 108: 1162-1168 [Abstract] [Full text] [PDF]
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eLetters published:

[Read eLetters] Missing treatment?
Teresa Meyer   (8 November 2001)
[Read eLetters] Re: Missing treatment
Marcus Spies   (16 November 2001)

Missing treatment? 8 November 2001
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Teresa Meyer,
Clinical Nurse Specialist
UW Children's Hospital, Madison, WI

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Re: Missing treatment?

tl.meyer{at}hosp.wisc.edu Teresa Meyer

I read with interest this description of treatment of TEN. Despite the fact that the majority of children had extensive debridement of affected skin and that numerous pharmacological and medical interventions were detailed, there was no mention of pain control or sedation agents that may have been used to assist in the recuperative period. are these not essential interventions for severely burned patients that deserve mention, or did the patients not receive these interventions?

Re: Missing treatment 16 November 2001
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Marcus Spies,
Burn Fellow
Shriners Hospital for Children

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Re: Re: Missing treatment

maspies{at}utmb.edu Marcus Spies

Dear Teresa,

in fact, this is good point. I apologize for not explicitly stating our pain managment protocol. This definitely should have been included in the manuscript.

In addition to benadryl (diphenhydramine) infusion at 1 mg/kg/h to stop the itching occuring with the skin sloughing in the early phase, we follow our standard pain protocol for burns. This consists of acetaminophen at 15 mg/kg/dose po q4h. If this should not be sufficient, it will be augmented by morphine iv at 0.33 mg/kg/dose iv q4h or morphine po at 0.1-0.3 mg/kg/dose q4h. However, in our clinical experience coverage of the large wound surfaces and protection of the raw dermis appears to be the most important factor to reduce pain. Continuing itching also appears to be of concern for the patient during the wound healing phase and shortly afterwards. This can be addressed by benadryl medication (po at 1.25 mg/kg/dose q6h).

I hope this clarifies your concerns and sufficiently answers your questions.

Marcus Spies MD Burn Fellow Shriners Hospital for Children - Galveston Burn Unit 815 Market St Galveston, TX 77550 maspies@utmb.edu