RASH

A broad term used to describe a dermatologic manifestation that may include hives, infections (fungal, viral, bacterial), insect bites, or contact dermatitis.

A. Obtain and record telephone triage assessment that includes:

• prior exposures, reactions, or anaphylaxis
• new products or medications

• location (localized or widespread, area of the body)
• size (approximate size of lesions, compare to the size of a dime, quarter, etc.)
• shape (linear, circular, grouped, scattered, etc.)
• color (pink, red, purple, yellow, brown, green)
• consistency (flat/smooth, raised/bumpy, hard, firm, soft, etc.)
• temperature (cool, warm, hot to touch)
• fluid filled, open, draining (signs of infection: redness, swelling, red streaks, etc.)

B. Risk Factors which may increase the acuity of a patient with a rash:

• Prior allergic reaction
• Chronic illness
• Immunosuppressed (congenital, acquired, or chemically induced)

C. See Immediately

Triage nurse should advise the use of an ambulance when the patient's current status is life threatening, may deteriorate enroute to hospital, or anxiety level is too high to safely drive to closest ED.

• Difficulty breathing, wheezing, and/or chest tightness
• Recent exposure to possible or known toxin with development of:
  • cough
  • slurred speech
  • swollen tongue
  • hoarseness
  • difficulty swallowing
• Wheezing after ingestion of medication, allergic food, or bee sting
  • use prescribed anaphylactic kit as directed for known allergies
• Purple or blood colored spots with or without a fever
• Fever greater than 105 degrees F.
• Bright red skin that peels off in sheets
• Severe headache with a fever > 100 degrees F.
• Hives began , < 2 hours ago & has had severe allergic reaction in the past
• Patient sounds very ill, weak, or toxic to triage nurse

D. See Within 4 Hours:

• Bright red area with a fever
• Spreading red streaks with a fever
• Newborn with tiny water blisters
• Hives or rash while taking an antibiotic with or without a fever
• Severe hives not improved 2 hours after taking Benadryl
• Very itchy rash not improved 2 hours after taking Benadryl
• Widespread rash with fever over 100 degree F and/or a sore throat
• Open sores with signs of infection
• Respiratory changes
• Marked facial swelling or eye lid swelling

E. See Within 24 Hours:

• Persistent rash, hives, or itching for > 24 hours not responding to home care
• Fever and/or sore throat
• Abdominal pain
• Joint pain or swelling
• Rash in the genital area

F. Home Care Advice:

• Wash area thoroughly to remove irritants
• Take cool bath for 20 minutes every 3-4 hours
  • add 1 cup of oatmeal, baking soda, or Aveeno to bath water
• Rub ice cube on itchy areas for 10 minutes as needed for relief
• Trim children's fingernails and/or cover infant's hands to discourage scratching
• Give Benadryl
  • 1 mg/kg/dose q 6-8 hours with a maximum single dose of 50 mg
  • do NOT give to children less than 20 pounds (9 kg) w/o MD approval
• For areas of severe itching, apply one of the following:
  • calamine lotion
  • 1% hydrocortisone cream
  • astringent
  • underarm deodorant which contains aluminum salts

H. Call Back If:

• Specific symptoms as outlined above develop
• Patient seems worse
• Increased concern, anxiety, or new questions
• Develops new symptoms or if symptoms change

(Briggs, 1997; Brown, 1994; Edwards, 1996; Grimes, 1992; Schmidt, 1994)

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