We review the medical issues and emergencies potentially encountered in the practice of general or surgical dermatology. Traditional guidelines have largely consisted of dated extrapolations from the nondermatologic literature concerning procedures that are primarily irrelevant to dermatology. This article outlines a rational approach to organizing an office emergency plan for anaphylaxis, stroke, status epilepticus, myocardial infarction, and hypertensive crisis. We discuss the literature that has influenced current office behavior regarding endocarditis prophylaxis, the use of electrosurgery with pacemakers, arrhythmogenic drug interactions, vasovagal syncope, lidocaine "allergy," and bleeding complications from oral anticoagulants. Recommendations for managing these issues in a dermatologic context are provided. (J Am Acad Dermatol 1997;36:1-16.)

Learning objective: At the conclusion of this learning activity, participants should be able to discuss emergencies and medical issues that the dermatologist may confront, the studies which have formed the basis of traditional guidelines, and the more recent literature available that can modify these guidelines with more rational and relevant recommendations.