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
Give loratadine (as per Standing Orders) for obvious minor urticarial / allergic rashes and / or itch
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
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
Australasian Society of Clinical Immunology and Allergy (2010) Urticaria Australasian Society of Clinical Immunology and Allergy, Balgowlah
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