We here at McKinney are a law firm dedicated to medical negligence for all people who have been misdiagnosed when they have had Steven Johnson Syndrome (SJS). As part of our goal to help those who have suffered at the hands of medical negligence, we want to also help you understand your syndrome. In this article, we will help you with the treatment and management of SJS. To avoid further medical negligence, this will help you have the conversation with your physician.

The management of SJS is usually provided in intensive care units (ICU) or burn centers. Unfortunately, there is no specific treatment of SJS and most management involves treating the symptoms. The patients affected by SJS are usually in a position they cannot speak, so we understand a lot of this information is for their family and loved ones.

The first people who are involved in the management are paramedics. It is their responsibility to recognize the presence of severe fluid loss and should treat patients with SJS as they would someone with thermal burns. Once you are in the emergency room (ED), the medical staff should make it their priority to hemodynacilly stable the patient with IV fluids and proper prophylactic antibiotics.

Initially, patients should be treated with special attention to airway, fluid status, wound/burn care, and pain control. Treatment will be primarily supportive and symptomatic. Some patients may require corticosteroids, cyclophosphamide, plasmapheresis, hemodialysis, and immunoglobulin, depending on the severity of the burns.

Next, it is important to manage oral lesions with mouthwashes. Topical anesthetics may help in reducing pain and allow the patient to take in fluids. The affected burned areas of denuded skin must be covered with compresses of saline or Burow solution. Also, it may be impertinent to address tetanus prophylaxis for patients whose immune history is unknown.

In the first 24 hours, fluid management is provided by macromolecules and saline solutions. Once the blood levels are available, phosphate salts are necessary in the presence of hypophosphatemia. After the second day of hospitalization, oral intake of fluids provided by nasogastric tube is begun, so that intravenous fluids can be tapered progressively and discontinued, usually in two weeks.

Massive parenteral nutrition is necessary as soon as possible to replace the protein loss and to promote healing of cutaneous lesions. Intravenous insulin therapy may be required because of impaired glycoregulation in settings of pancreatic or liver injury. When the environmental temperature is raised to 30-32°C, it reduces caloric loss through the skin. Fluidized air beds are recommended if a large portion of the skin on the patient’s backside is involved. Heat shields and infrared lamps are used to help reduce heat loss.

Anticoagulation with heparin for the duration of hospitalization is recommended to avoid an embolus. Antacids reduce the incidence of gastric bleeding, but should be regularly monitored via complete blood counts and metabolic panels. Pulmonary care will include aerosols, bronchial aspiration, and physical therapy. Also, patients with SJS are at a high risk of infection. Sterile handling and/or reverse-isolation nursing techniques are essential to decrease the risk of nosocomial infection.

Cultures of blood (CBC, CMP), BMP), catheters, gastric tubes, and urinary tubes must be performed regularly. Antiseptics, such as 0.5% silver nitrate or 0.05% chlorhexidine, to paint and bathe the affected skin areas. Antimicrobials are indicated in cases of urinary tract or cutaneous infections, either of which may lead to bacteriemia. The use of antibiotics should always be further justified with cultures.

If you or a loved one have been diagnosed with SJS and have any concerns or would like to file a suit for medical negligence, contact us today at McKinney.