Determine renal function and evaluate urine for blood. Electrolytes and other chemistries may be needed to help manage related problems. Cultures of blood, urine, and wounds are indicated when an infection is clinically suspected. Chest radiograph may indicate the existence of a pneumonitis when clinically suspected. Otherwise, routine plain films are not indicated.
Skin biopsy demonstrates that the bullae are subepidermal.
Epidermal cell necrosis may be noted. Perivascular areas are infiltrated with lymphocytes. Paramedics should recognize the presence of severe fluid loss and should treat patients with SJS as they would patients with thermal burns. Most cases present early and prior to obvious signs of hemodynamic compromise. Perhaps the single most important role for the ED physician is to detect SJS early and initiate the appropriate ED and inpatient management.