Anaphylaxis on the Other Front Line: Perspectives from the Emergency Department - 31/12/13
Abstract |
Although most cases of anaphylaxis are treated in the emergency department (ED), personnel may not immediately recognize anaphylaxis based on presenting symptoms because it has a wide range of clinical manifestations and variable progression. When symptoms happen to be atypical or mild and when no trigger is identified, the diagnosis of anaphylaxis can be challenging. Underdiagnosis of anaphylaxis can lead to delayed use of appropriate first-line epinephrine in favor of treatments that should be used as adjunctive only. Even when anaphylaxis is recognized, the choice between an epinephrine autoinjector or epinephrine ampule can still present a challenge. Treatment of anaphylaxis in the ED should include a combination of intramuscular epinephrine, supplemental oxygen, and intravenous fluids. If there is an incomplete response to the initial dose of epinephrine, additional doses or other measures may be considered. The most important management consideration is avoiding treatment delays, because symptoms can progress rapidly. Upon discharge from the ED, all patients with anaphylaxis should be given a prescription for at least 2 epinephrine autoinjectors, an initial emergency action plan, education about avoidance of triggers, and a referral to an allergist. A significant limitation of current studies is that clinical outcomes in anaphylaxis associated with established poor rates of diagnosis and use of recommended treatments are unclear; such trials must be conducted as supporting evidence for ED management guidelines for anaphylaxis.
Le texte complet de cet article est disponible en PDF.Keywords : Allergy, Anaphylaxis, Discharge planning, Emergency action plan, Emergency medicine, Epinephrine, Evidence-based guidelines
Plan
Funding: This work was supported by Mylan Specialty L.P. |
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Conflict of Interest: Richard M. Nowak, MD, MBA, FACEP, FAAEM, has served as a consultant to Mylan Specialty L.P., including receipt of an honorarium for attending the Partnership for Anaphylaxis Round Table. No payment was received for the writing of this manuscript. Charles G. Macias, MD, MPH, FAAP, FACEP, has served as an advisor for Mylan Specialty L.P., including receipt of an honorarium for attending the Partnership for Anaphylaxis Round Table. No payment was received for the writing of this manuscript. |
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Authorship: Drs Nowak and Macias both fully qualify for authorship of the manuscript, having made substantial contributions to the conception and design of the work; the acquisition, analysis, and interpretation of data for the work; and the identification and interpretation of the appropriate published literature. Both authors were involved in drafting and critically revising the manuscript for important intellectual content, reviewed the final manuscript, and gave approval for submission. Drs Nowak and Macias are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
Vol 127 - N° 1S
P. S34-S44 - janvier 2014 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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