Continuing medical educationDermatologic surgery emergencies: Complications caused by systemic reactions, high-energy systems, and trauma
Section snippets
Anaphylaxis
Key points Anaphylaxis is the most dramatic and potentially catastrophic manifestation of immediate hypersensitivity Severity of reactions can vary widely from mild pruritus and urticaria to shock and death The key to anaphylaxis management is prompt recognition Intramuscular epinephrine is the first-line treatment of patients with suspected anaphylaxis
Cardiac arrhythmia
Key points Cardiac arrhythmias are associated with multiple etiologies, some of which can occur during dermatologic interventions Instances of cardiac arrhythmias during phenol chemical peels have been described Ventricular arrhythmias, especially ventricular fibrillation, herald a life-threatening emergency and must be managed promptly Clinical features of ventricular fibrillation include faintness, loss of consciousness, seizures, and apnea Successful management of cardiac arrest is based on adequate
Fire
Key points Each year in the United States there are approximately 50 to 650 surgical fires, the majority of which involve electrosurgical or laser devices Three elements are commonly required to initiate and maintain a fire: an ignition source, a fuel, and an oxidizer Specific steps can be taken pre- and perioperatively to help prevent surgical fires
Laser eye injury
Key points Eye safety is of the utmost importance during laser therapy When an eye injury does occur, wavelength, exposure duration, and laser intensity are all primary factors in determining the extent of the injury Injury to the eye may be temporary, but it also has the potential to result in permanent vision loss Laser eye injury should motivate emergent ophthalmologic referral Management of laser-mediated retinal injury is designed to reduce the inflammatory response While eye protective measures like
Local anesthetic and lidocaine toxicity
Key points Lidocaine toxicity, although rare, is a reported complication of dermatologic surgery Symptoms of lidocaine toxicity vary based on serum lidocaine concentrations The maximum safe dose of lidocaine in an adult is 5 mg/kg without epinephrine and 7 mg/kg with epinephrine. If dilute tumescent anesthesia is being used for large procedures, the known safe dose of lidocaine with epinephrine is 55 mg/kg If patients experience any of the signs and symptoms associated with excess serum lidocaine, vital
Motor nerve transection
Key points The nerves at greatest risk for injury during cutaneous surgery are the temporal and marginal mandibular branches of the facial nerve and the spinal accessory nerve The temporal nerve is most susceptible to transection superior to the zygomatic arch and lateral to the lateral eyebrow Clinical presentation of temporal nerve transection is a flattened forehead, eyebrow ptosis, and an inability to raise the ipsilateral eyebrow The marginal mandibular nerve is at greatest risk in the neck because of
Retrobulbar hematoma
Key points Retrobulbar hematoma can present as a complication of eyelid surgery Risk factors that increase the risk for postoperative hematoma formation are those associated with bleeding Pathophysiologic similarity to compartment syndrome, in which pressure causes ischemia and neural damage, has been suggested as a mechanism Common presentations of retrobulbar hematoma may occur ≤24 hours of surgery, but delayed presentations have been observed more than several days later The management of retrobulbar
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Cardiac arrhythmias during phenol face peeling
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Local anesthetics: review of pharmacological considerations
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Local anaesthesia and the dermatologist
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Atrial fibrillation: Clinical features, mechanisms, and management
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Cardiac arrest and sudden cardiac death
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2018, Journal of the American Academy of DermatologyCitation Excerpt :Key points Fillers and botulinum toxin are extremely safe, with exceedingly low rates of adverse events when used by expert, board-certified dermatologist injectors.36,74-107 Injectable nonpermanent fillers do not require skin testing before use and are generally considered nonimmunogenic.
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Funding sources: None.
Conflicts of interest: None declared.
Date of release: August 2016
Expiration date: August 2019