› ! Urticaria (acute) → › ! Scabies → First 5 minutes critical patient workflow
› Immediate stabilization
› Airway compromise signs
› Oxygen for hypoxia
› Cardiac monitoring for hypotension or tachyarrhythmia
› IV access for unstable vitals
› Immediate treatment triggers
› If anaphylaxis features then IM epinephrine per local protocol dependent
› If hypotension then IV fluids per shock pathway
› Time targets
› If systemic allergic reaction concern then epinephrine within minutes
› If sepsis concern then lactate and cultures within 1 hour per local protocol dependent
› Skin care and barrier support
› Thick emollient multiple times daily
› Lukewarm showers
› Avoid fragranced products
› Antihistamine strategy
› Non sedating daytime option
› Cetirizine PO 10 mg daily adult example
› Sedating nighttime option when sleep disruption
› Hydroxyzine PO 25 mg at bedtime adult example
› Topical antipruritic options
› Pramoxine topical as needed
› Menthol camphor lotion as needed
› Neuropathic itch options
› Consider gabapentin when neuropathic pattern and no contraindications
› Renal dosing adjustment required
Etiology directed management
› Cholestasis pathway
› RUQ ultrasound if cholestatic labs or jaundice
› Early GI or surgery discussion if obstruction suspected
› Uremic pruritus pathway
› Renal function optimization
› Dialysis adequacy review via nephrology for dialysis patients
› Infestation pathway
› Permethrin 5 percent topical for scabies suspected
› Treat close contacts and bedding
› Medication induced pruritus pathway
› Stop suspected offending agent when safe
› Alternative medication plan via prescriber
› Recheck interval
› 30 to 60 minutes after initial symptom therapy
› Earlier if unstable vitals
› Recheck elements
› Vitals
› Airway symptoms
› Pruritus severity score
› New rash or hives emergence
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