Rash Nurse Management Guidelines

Red Flag Exclusion Criteria

  • Child at risk of significant harm

  • Suspected non-accidental injury

  • Unplanned repeat ED presentation

  • Infant ≤ 3 months

  • Haemorrhagic and / or non-blanching rash

  • Facial and / or neck swelling

  • Swelling inside the mouth

  • Respiratory difficulty or stridor

  • Any associated fever

  • Vomiting or abdominal pain

  • Rash with associated pain

  • Vesicular type rash

  • Suspected, or history of previous, anaphylaxis

  • History of workplace injury

  • Yellow or Red Zones observations or additional criteria outlined in the NSW Health Standard Between The Flags Observation Charts 

Additional History

  • Description and location/s of rash

  • Immunisation status

  • Relevant social and infectious contacts

  • Current medications

  • Recent overseas travel - record and flag for follow-up with doctor

  • Use the following Rash Chart to help identify rash:

Rash Chart - adapted from Hunter New England Health

Management Principles

  1. Give loratadine (as per Standing Orders) for obvious minor urticarial / allergic rashes and / or itch

  2. Provide analgesia as required according to pain scale. Refer to Pain NMG.

If onset of rash is recent (≤ 1 hour) and possibly of an allergic nature, patient must be observed in the ED for at least 1 hour for signs of worsening allergic symptoms which may indicate anaphylaxis.

References / Further Resources

  1. Australasian Society of Clinical Immunology and Allergy (2010) Is it Allergy? The allergic child – early recognition and diagnosis Australasian Society of Clinical Immunology and Allergy, Balgowlah

  2. Australasian Society of Clinical Immunology and Allergy (2010) Urticaria Australasian Society of Clinical Immunology and Allergy, Balgowlah

  3. NSW Department of Health (2011) Recognition of a Sick Baby or Child in the Emergency Department Clinical Practice Guidelines (2nd Ed.) NSW Department of Health, North Sydney

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