DOCSLIB.ORG

Anaphylaxis V6.2: ED Higher Initial Clinical Concern

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

Anaphylaxis v6.2: ED Higher Initial Clinical Concern Approval & Citation Summary of Version Changes Explanation of Evidence Ratings Inclusion Criteria > 3 months with suspected anaphylaxis Exclusion Criteria • Blood transfusion reactions that are not anaphylaxis • Symptoms clearly attributable to other causes High clinical Go to concern for NO Lower Clinical anaphylaxis? Concern YES • Give epinephrine 0.01mg/kg IM (max 0.3mg) in lateral thigh • Repeat every 5 min as needed (can give more frequently if symptoms are severe) • Place on monitors, vitals every 5 minutes Symptoms Suggestive of Anaphylaxis • Place patient supine if tolerated • Avoid sudden changes in position, Mild Symptoms: especially to standing • Generalized erythema, hives, angioedema • Administer O2 until O2 Sat is known, and to Moderate Symptoms: keep O2 saturation > 90% • Chest or throat tightness • Dyspnea, stridor, wheeze • If MAP <5th %ile → place IV and • Nausea, vomiting, abdominal pain administer N/S 20 cc/kg • Dizziness (presyncope), diaphoresis • If bronchospasm→ place IV and Severe Symptoms: • Cyanosis, saturation <= 92% give albuterol 20 mg / hr or 8 puffs • Hypotension, collapse • Confusion, LOC Observe for 5-10 mins • Incontinence Continue monitoring with vitals every 5 minutes Risk Factors for Anaphylaxis • Possible exposure to know allergen • Home anaphylaxis management plan Adapted from Brown, 2004 Has patient improved? YES NO Go to Historical factors that increase risk and warrant a lower threshold for epinephrine: • prior anaphylaxis involving respiratory distress Go to Go to • hypoxia Moderate - • hypotension Mild • neurologic compromise Severe From Wang 2017 For questions concerning this pathway, Last Updated: June 2021 contact: [email protected] Next Expected Review: August 2022 © 2021 Seattle Children’s Hospital, all rights reserved, Medical Disclaimer Anaphylaxis v6.2: ED Lower Initial Clinical Concern Approval & Citation Summary of Version Changes Explanation of Evidence Ratings Inclusion Criteria > 3 months with suspected Symptoms Suggestive of Anaphylaxis anaphylaxis Mild Symptoms: Exclusion Criteria • Generalized erythema, hives, • Blood transfusion reactions • Blood transfusion reactions angioedema that are not anaphylaxis Moderate Symptoms: • Symptoms clearly • Chest or throat tightness attributable to • Dyspnea, stridor, wheeze other causes • Nausea, vomiting, abdominal pain • Dizziness (presyncope), diaphoresis Severe Symptoms: • Cyanosis, saturation <= 92% Lower • Hypotension, collapse clinical concern • Confusion, LOC for anaphylaxis? • Incontinence Risk Factors for Anaphylaxis • Possible exposure to know allergen YES • Home anaphylaxis management plan Adapted from Brown, 2004 Use the Anaphylaxis Score Assisting Providers (ASAP) Score Score 1-4 >5 Rapid symptom Epinephrine is progression or likely indicated. YES epinephrine indicated per Huddle with team patient action plan? to discuss • Give epinephrine 0.01mg/kg IM (max 0.3mg) in lateral thigh NO • Repeat every 5 mins as needed (can give more frequently if symptoms are severe) Go to Mild Has patient YES NO improved? Go to Go to Mild Moderate - Severe For questions concerning this pathway, Last Updated: June 2021 contact: [email protected] Next Expected Review: August 2022 © 2021 Seattle Children’s Hospital, all rights reserved, Medical Disclaimer Anaphylaxis v6.2: ED Management – Mild Approval & Citation Summary of Version Changes Explanation of Evidence Ratings Resolved after epinephrine or no epinephrine given Inclusion Criteria > 3 months with suspected anaphylaxis Exclusion Criteria • BloodBlood transfusion transfusion reactions thatreactions are not anaphylaxisthat are not • Symptoms clearly attributable to other causes Use “ED Anaphylaxis Panel” if patient has received epinephrine, or has cutaneous symptoms: • Cetirizine PO • H2 receptor blocker PO Assess for risk factors • History of biphasic or severe reaction • History of asthma or wheezing • Time from exposure to symptom onset delayed > 1 hour or unknown ! Steroids Symptoms resolved AND Symptoms persist OR with risk factors absent risk factors present immunotherapy No steroids dexamethasone PO Evaluate and score hourly and with symptom change NOT worse or Epinephrine is worse or score likely indicated. score >5 Huddle with team 1-4 to discuss. Go to Go to ED Disposition Moderate - Severe For questions concerning this pathway, Last Updated: June 2021 contact: [email protected] Next Expected Review: August 2022 © 2021 Seattle Children’s Hospital, all rights reserved, Medical Disclaimer Anaphylaxis v6.2: ED Management – Moderate/Severe Approval & Citation Summary of Version Changes Explanation of Evidence Ratings Epinephrine given Inclusion Criteria > 3 months with suspected anaphylaxis Exclusion Criteria • BloodBlood transfusion transfusion reactions thatreactions are not anaphylaxisthat are not • Symptoms clearly attributable to other causes Epinephrine has been given YES & observed for 5-10 mins Score patient using ASAP Go to NOT improved or Mild Improved or score score 1-4 >5 Give epinephrine 0.01mg/kg IM (max 0.3mg) in lateral thigh Use “ED Anaphylaxis Panel” • Place IV (if not already done) • Cetirizine PO (unless unable to tolerate PO, then diphenhydramine IV) • H2 Blocker IV • MethylPrednisolone IV ! Steroids with Observe for 5-10 min immunotherapy -continue monitoring, vitals every 5 minutes NOT Improved improved or or score score 1-4 >5 • Consider epinephrine 0.01mg/kg IM (max Go to 0.3mg) in lateral thigh ED Disposition • Repeat every 5 min as needed (can give more frequently if symptoms are severe) • Start epinephrine drip after 3rd IM dose • PICU consult, admit to PICU For questions concerning this pathway, Last Updated: June 2021 contact: [email protected] Next Expected Review: August 2022 © 2021 Seattle Children’s Hospital, all rights reserved, Medical Disclaimer Anaphylaxis v6.2: ED Disposition Approval & Citation Summary of Version Changes Explanation of Evidence Ratings Urgent Care Transfer Recommendations Transfer patients who have received IM Epinephrine to the Emergency Department ! • Patients should be transported by ALS (or an ambulance crew If not who is able to give IM epienphrine) improving, consider • Patients who have low BP or require more than one dose of alternate diagnoses epinephrine, consider calling 911 (or Code Blue) • Patient requiring observation after 1 hour- transfer to ED Patient NO received YES • Observe for 1 hour if symptoms are stable, or 1 epinephrine? hour after any symptom progression. • If anaphylaxis high risk by history: observe for 4 Meets hours from either exposure or any symptom admission progression. NO Criteria? High risk by history: YES: Acute Care • History of anaphylaxis • History of life-threatening allergies (versus environmental) • Two systems involved at any point Assessment Acute Care Observe for 4 hours from the latest of: Admit Criteria exposure, epinephrine administration, or any • Persistent symptoms worsening of symptoms beyond rash or score > 5 after 2 epinephrine Discharge Criteria Observe for 3 hours “LIKE A ROSE” patients • Persistent wheeze or • Score 1-4, no symptom meeting all these criteria : bronchospasm after progression during • ASAP – max 2, points for exposure only 1 epinephrine observation period • No hypotension or syncope during event • Biphasic reaction • Teaching completed • No wheeze, stridor or resp distress during event • Tolerating PO intake • No URI symptoms even if baseline • No sleepiness even if late in day • No history of biphasic reactions YES: PICU • Reaction to a food, not a medication or a sting • Parents comfortable with early discharge Discharge Instructions • Epinephrine auto-injector in hand • Provide anaphylaxis discharge materials e.g. FARE Field Guide and Anaphylaxis Emergency Care Plan • Rx epinephrine auto-injector and provide training PICU Criteria • RASH Hx, discharge with • Persistent MAP <5% ile - Cetirizine prn • Altered mental status after 1 epinephrine - H2 receptor blocker PRN • > 3 doses of epinephrine given with persistent symptoms x3 days beyond rash/ angioedema • No RASH Hx, discharge with no • Persistent cardiovascular compromise meds • Persistent respiratory distress • Recommend allergist referral • Continuous albuterol for > 1 hour • F/U PCP within 3 days For questions concerning this pathway, Last Updated: June 2021 contact: [email protected] Next Expected Review: August 2022 © 2021 Seattle Children’s Hospital, all rights reserved, Medical Disclaimer Anaphylaxis v6.2: Inpatient Continued Management Approval & Citation Summary of Version Changes Explanation of Evidence Ratings Use “Anaphylaxis for Inpatient” Panel Symptoms Suggestive of Anaphylaxis Inclusion Criteria > 3 months with suspected Patients to receive adjunctive medications below: Mild Symptoms: anaphylaxis • Prednisone/prednisolone daily • Generalized erythema, hives, Exclusion Criteria • If persistent cutaneous symptoms: angioedema •• BloodBlood transfusion transfusion reactions - Cetirizine PRN Moderate Symptoms: thatreactions are not anaphylaxisthat are not - H2 receptor blocker • Chest or throat tightness • Symptoms clearly PRN medications: • Dyspnea, stridor, wheeze attributable to • Epinephrine 0.01mg/kg IM (max 0.3mg) in lateral • Nausea, vomiting, abdominal pain other causes thigh for anaphylaxis • Dizziness (presyncope), diaphoresis • Albuterol 8 puffs for bronchospasm Severe Symptoms: • Ondansetron for nausea or vomiting • Cyanosis, saturation
Recommended publications
  • Differentiating Between Anxiety, Syncope & Anaphylaxis

    Differentiating Between Anxiety, Syncope & Anaphylaxis

    Differentiating between anxiety, syncope & anaphylaxis Dr. Réka Gustafson Medical Health Officer Vancouver Coastal Health Introduction Anaphylaxis is a rare but much feared side-effect of vaccination. Most vaccine providers will never see a case of true anaphylaxis due to vaccination, but need to be prepared to diagnose and respond to this medical emergency. Since anaphylaxis is so rare, most of us rely on guidelines to assist us in assessment and response. Due to the highly variable presentation, and absence of clinical trials, guidelines are by necessity often vague and very conservative. Guidelines are no substitute for good clinical judgment. Anaphylaxis Guidelines • “Anaphylaxis is a potentially life-threatening IgE mediated allergic reaction” – How many people die or have died from anaphylaxis after immunization? Can we predict who is likely to die from anaphylaxis? • “Anaphylaxis is one of the rarer events reported in the post-marketing surveillance” – How rare? Will I or my colleagues ever see a case? • “Changes develop over several minutes” – What is “several”? 1, 2, 10, 20 minutes? • “Even when there are mild symptoms initially, there is a potential for progression to a severe and even irreversible outcome” – Do I park my clinical judgment at the door? What do I look for in my clinical assessment? • “Fatalities during anaphylaxis usually result from delayed administration of epinephrine and from severe cardiac and respiratory complications. “ – What is delayed? How much time do I have? What is anaphylaxis? •an acute, potentially
  • (Loxapine) REMS

    (Loxapine) REMS

    Current as of 6/1/2013.® This document may not be part of the latest approved REMS. Alexza Pharmaceuticals, Inc. 2091 Stierlin Court, Mountain View, CA 94043 IMPORTANT DRUG WARNING Risk of bronchospasm with ADASUVE™ (loxapine) inhalation powder ADASUVE™ available only in enrolled healthcare facilities, under an FDA-required REMS Program Dear Healthcare Professional: This letter contains important safety information for ADASUVE™ (loxapine) Inhalation Powder. ADASUVE is a drug-device combination product that delivers the antipsychotic, loxapine, by oral inhalation. ADASUVE has been approved by the US Food and Drug Administration (FDA) for the acute treatment of agitation associated with schizophrenia or bipolar I disorder in adults. FDA has determined that a Risk Evaluation and Mitigation Strategy (REMS) is necessary to ensure that the benefits of treatment outweigh the risk of bronchospasm in patients treated with ADASUVE. ADASUVE is not available in an outpatient setting. If you are an outpatient provider, you are receiving this letter because ADASUVE may be, or may have been, administered to one of your patients in an enrolled healthcare facility. Enrolled healthcare facilities, such as an acute care or inpatient setting, must have immediate on-site access to equipment and personnel trained to manage acute bronchospasm, including advanced airway management, eg, intubation and mechanical ventilation. (See below for more facility enrollment requirements.) It is important that anyone caring for patients treated with ADASUVE be aware of the risk of bronchospasm after administration. This letter does not contain a complete list of all the risks associated with ADASUVE. Reference ID:Please 3235446 see the enclosed full prescribing information for more information.
  • Inhaled Loxapine Monograph

    Inhaled Loxapine Monograph

    Inhaled Loxapine Monograph Inhaled Loxapine (ADASUVE) National Drug Monograph February 2015 VA Pharmacy Benefits Management Services, Medical Advisory Panel, and VISN Pharmacist Executives The purpose of VA PBM Services drug monographs is to provide a comprehensive drug review for making formulary decisions. Updates will be made when new clinical data warrant additional formulary discussion. Documents will be placed in the Archive section when the information is deemed to be no longer current. FDA Approval Information Description/Mechanism of Inhaled loxapine is a typical antipsychotic used in the treatment of acute Action agitation associated with schizophrenia and bipolar I disorder in adults. Loxapine’s mechanism of action for reducing agitation in schizophrenia and bipolar I disorder is unknown. Its effects are thought to be mediated through blocking postsynaptic dopamine D2 receptors as well as some activity at the serotonin 5-HT2A receptors. Indication(s) Under Review in Inhaled loxapine is a typical antipsychotic indicated for the acute treatment of this document (may include agitation associated with schizophrenia or bipolar I disorder in adults. off label) Off-label use Agitation related to any other cause not due to schizophrenia and bipolar I disorder. Dosage Form(s) Under 10mg oral inhalation using a new STACCATO inhaler device. Review REMS REMS No REMS Post-marketing Study Required See Other Considerations for additional REMS information Pregnancy Rating C Executive Summary Efficacy Inhaled loxapine was superior to placebo in reducing acute agitation at 2 hours post dose measured by the Positive and Negative Syndrome Scale-Excited Component (PEC) in patients with bipolar I disorder and schizophrenia.
  • An Avoidable Cause of Thymoglobulin Anaphylaxis S

    An Avoidable Cause of Thymoglobulin Anaphylaxis S

    Brabant et al. Allergy Asthma Clin Immunol (2017) 13:13 Allergy, Asthma & Clinical Immunology DOI 10.1186/s13223-017-0186-9 CASE REPORT Open Access An avoidable cause of thymoglobulin anaphylaxis S. Brabant1*, A. Facon2, F. Provôt3, M. Labalette1, B. Wallaert4 and C. Chenivesse4 Abstract Background: Thymoglobulin® (anti-thymocyte globulin [rabbit]) is a purified pasteurised, gamma immune globulin obtained by immunisation of rabbits with human thymocytes. Anaphylactic allergic reactions to a first injection of thymoglobulin are rare. Case presentation: We report a case of serious anaphylactic reaction occurring after a first intraoperative injection of thymoglobulin during renal transplantation in a patient with undiagnosed respiratory allergy to rabbit allergens. Conclusions: This case report reinforces the importance of identifying rabbit allergy by a simple combination of clini- cal interview followed by confirmatory skin testing or blood tests of all patients prior to injection of thymoglobulin, which is formally contraindicated in patients with a history of hypersensitivity to rabbit proteins. Keywords: Thymoglobulin, Anaphylactic allergic reaction, Rabbit proteins Background [7]. Cases of serious anaphylactic reactions to thymo- Thymoglobulin is an IgG fraction purified from the globulin due to rabbit protein allergy are very rare, and serum of rabbits immunised against human thymocytes. consequently, specific tests for rabbit allergy are not The preparation consists of polyclonal antilymphocyte usually performed as part of the pre-transplant assess- IgG directed against T lymphocyte surface antigens, and ment. We report a case of serious anaphylactic reaction induction of profound lymphocyte depletion is though due to rabbit protein allergy following a first injection of to be the main mechanism of thymoglobulin-mediated thymoglobulin.
  • Hypersensitivity Reactions (Types I, II, III, IV)

    Hypersensitivity Reactions (Types I, II, III, IV)

    Hypersensitivity Reactions (Types I, II, III, IV) April 15, 2009 Inflammatory response - local, eliminates antigen without extensively damaging the host’s tissue. Hypersensitivity - immune & inflammatory responses that are harmful to the host (von Pirquet, 1906) - Type I Produce effector molecules Capable of ingesting foreign Particles Association with parasite infection Modified from Abbas, Lichtman & Pillai, Table 19-1 Type I hypersensitivity response IgE VH V L Cε1 CL Binds to mast cell Normal serum level = 0.0003 mg/ml Binds Fc region of IgE Link Intracellular signal trans. Initiation of degranulation Larche et al. Nat. Rev. Immunol 6:761-771, 2006 Abbas, Lichtman & Pillai,19-8 Factors in the development of allergic diseases • Geographical distribution • Environmental factors - climate, air pollution, socioeconomic status • Genetic risk factors • “Hygiene hypothesis” – Older siblings, day care – Exposure to certain foods, farm animals – Exposure to antibiotics during infancy • Cytokine milieu Adapted from Bach, JF. N Engl J Med 347:911, 2002. Upham & Holt. Curr Opin Allergy Clin Immunol 5:167, 2005 Also: Papadopoulos and Kalobatsou. Curr Op Allergy Clin Immunol 7:91-95, 2007 IgE-mediated diseases in humans • Systemic (anaphylactic shock) •Asthma – Classification by immunopathological phenotype can be used to determine management strategies • Hay fever (allergic rhinitis) • Allergic conjunctivitis • Skin reactions • Food allergies Diseases in Humans (I) • Systemic anaphylaxis - potentially fatal - due to food ingestion (eggs, shellfish,
  • Beta Adrenergic Agents

    Beta Adrenergic Agents

    Beta2 Adrenergic Agents –Long Acting Review 04/10/2008 Copyright © 2007 - 2008 by Provider Synergies, L.L.C. All rights reserved. Printed in the United States of America. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, digital scanning, or via any information storage and retrieval system without the express written consent of Provider Synergies, L.L.C. All requests for permission should be mailed to: Attention: Copyright Administrator Intellectual Property Department Provider Synergies, L.L.C. 5181 Natorp Blvd., Suite 205 Mason, Ohio 45040 The materials contained herein represent the opinions of the collective authors and editors and should not be construed to be the official representation of any professional organization or group, any state Pharmacy and Therapeutics committee, any state Medicaid Agency, or any other clinical committee. This material is not intended to be relied upon as medical advice for specific medical cases and nothing contained herein should be relied upon by any patient, medical professional or layperson seeking information about a specific course of treatment for a specific medical condition. All readers of this material are responsible for independently obtaining medical advice and guidance from their own physician and/or other medical professional in regard to the best course of treatment for their specific medical condition. This publication, inclusive of all forms contained herein, is intended to be educational in nature and is intended to be used for informational purposes only. Comments and suggestions may be sent to [email protected].
  • Anaphylaxis Following Administration of Extracorporeal Photopheresis for Cutaneous T Cell Lymphoma

    Anaphylaxis Following Administration of Extracorporeal Photopheresis for Cutaneous T Cell Lymphoma

    Volume 26 Number 9| September 2020| Dermatology Online Journal || Letter 26(9):18 Anaphylaxis following administration of extracorporeal photopheresis for cutaneous T cell lymphoma Jessica Tran1,2, Lisa Morris3, Alan Vu4, Sampreet Reddy1, Madeleine Duvic1 Affiliations: 1Department of Dermatology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA, 2Baylor College of Medicine, Houston, Texas, USA, 3University of Missouri Columbia School of Medicine, Columbia, Missouri , USA, 4University of Texas McGovern Medical School, Houston, Texas, USA Corresponding Author: Madeleine Duvic MD, Department of Dermatology, The University of Texas MD Anderson Cancer Center, Unit 1452, 1515 Holcombe Boulevard, Houston, TX 77030, Tel: 713-792-6800, Email: [email protected] peripheral blood from a patient, (ii) separating the Abstract white blood cells from whole blood by Extracorporeal photopheresis is a non-invasive centrifugation, (iii) adding psoralen, a therapy used for the treatment of a range of T cell photosensitizing agent, to the white blood cells, (iv) disorders, including cutaneous T cell lymphoma. exposing the white blood cells to ultraviolet A (UVA) During extracorporeal photopheresis, peripheral radiation, and (v) re-infusing the treated white blood blood is removed from the patient and the white blood cells are separated from whole blood via cells to the patient [3]. The re-infusion of apoptotic centrifugation. The white blood cells are exposed to leukocytes triggers an immune response resulting in psoralen (a photosensitizing agent) and ultraviolet A production of CD8+ tumor suppressor cells in CTCL radiation, causing cell apoptosis. The apoptotic [3]. Extracorporeal photopheresis is generally leukocytes are subsequently re-infused into the regarded as safe with few side effects [3].
  • How to Recognise and Manage Mild to Moderate Allergic Reactions in Children Information for Parents and Carers Contents Page What Is an Allergic Reaction? 2

    How to Recognise and Manage Mild to Moderate Allergic Reactions in Children Information for Parents and Carers Contents Page What Is an Allergic Reaction? 2

    Children’s Allergy Clinic How to recognise and manage mild to moderate allergic reactions in children Information for parents and carers Contents Page What is an allergic reaction? 2 What can cause allergic reactions? 3 How to avoid contact with allergens 4 Signs and symptoms 6 Action plan 7 Nurseries, child-minders, schools/activity groups 9 Further information 11 What is an allergic reaction? An allergic reaction happens when the body’s immune system over-reacts to contact with normally harmless substances. An allergic person’s immune system treats certain substances as threats and releases substances such as histamines to defend the body against them. The release of histamine can cause the body to produce a range of mild to severe symptoms. An allergic response can develop after touching, swallowing, tasting, eating or breathing-in a particular substance. page 2 What can cause allergic reactions? Foods For example: • nuts (especially peanuts) • fish and shellfish • eggs and milk. Most allergic reactions to food occur immediately after swallowing, although some can occur up to several hours afterwards. Food allergies are more common in families who have other allergic conditions such as asthma, eczema and hay fever. Rarely, people have an allergic reaction to fruit, vegetables and legumes. Legumes include pulses, beans, peas and lentils. Peanuts are also part of the legume family. Insect stings • Reaction to an insect sting is immediate (within 30 minutes). Natural rubber latex Some common sources of latex are: • balloons • rubber bands • carpet backing • furniture filling • medical or dental items such as catheters, gloves, disposable items. Medicines Medication rarely causes a severe allergic reaction in children.
  • COVID-19 Vaccine and Allergy

    COVID-19 Vaccine and Allergy

    COVID Vaccine and Allergy Stephanie Leonard, MD Associate Clinical Professor Department of Pediatric Allergy & Immunology January 20, 2020 Safe and Impactful • Proper Screening COVID Vaccine • Monitoring Administration • Clinical Assessment • Vaccine Adverse Event Reporting System (VAERS) detected 21 cases of anaphylaxis after administration of a reported 1,893,360 first doses of the Pfizer-BioNTech COVID-19 vaccine • 11.1 cases per million doses (0.001%) • 1.3 cases per million for flu vaccines • 71% occurred within 15 min of vaccination, 86% within 30 minutes • Range = 2–150 minutes • Of 20 with follow-up info, all had recovered or been discharged home. • 17 (81%) with h/o allergies to food, vaccine, medication, venom, contrast, or pets. • 4 with no h/o any allergies • 7 with h/o anaphylaxis • Rabies vaccine • Flu vaccine • 19 (90%) diffuse rash or generalized hives Allergic Reactions Including Anaphylaxis After Receipt of the First Dose of Pfizer-BioNTech COVID-19 Vaccine — United States, December 14–23, 2020. MMWR Morb Mortal Wkly Rep 2021;70:46–51. Early Signs of Anaphylaxis • Respiratory: sensation of throat closing*, stridor, shortness of breath, wheeze, cough • Gastrointestinal: nausea*, vomiting, diarrhea, abdominal pain • Cardiovascular: dizziness*, fainting, tachycardia, hypotension • Skin/mucosal: generalized hives, itching, or swelling of lips, face, throat *these can be subjective and overlap with anxiety or vasovagal syndrome Labs that can help assess for anaphylaxis • Tryptase, serum (red top tube) • C5b-9 terminal complement complex Level, serum (SC5B9) (lavender top EDTA tube) Emergency Supplies Management of anaphylaxis at a COVID-19 vaccination site • If anaphylaxis is suspected, take the following steps: • Rapidly assess airway, breathing, circulation, and mentation (mental activity).
  • BREATHLESSNESS ABSTRACT INTRODUCTION Dyspnoea, Also

    BREATHLESSNESS ABSTRACT INTRODUCTION Dyspnoea, Also

    EMERGENCY MEDICINE – WHAT THE FAMILY PHYSICIAN CAN TREAT UNIT NO. 4 BREATHLESSNESS In one study of 85 patients presenting to a pulmonary unit Psychiatric conditions appropriate context of the history, physical examination, and ischaemia. Serial measurements of cardiac biomarkers are inhaler (MDI). In severe asthma, patients should be transferred breathlessness. In such cases, it is prudent to start therapies for with a complaint of chronic dyspnoea, the initial impression Psychogenic causes for acute dyspnoea is a diagnosis of the consideration of dierential diagnosis. Random testing necessary as initial results can often be normal. to ED for further treatment with nebulised ipratropium multiple conditions in the initial resuscitative phase. For Dr Pothiawala Sohil of the aetiology of dyspnoea based upon the patient history exclusion, and organic causes must be ruled out rst before without a clear dierential diagnosis will delay appropriate bromide, intravenous magnesium, ketamine, IM adrenaline, example, for a patient with a past medical history of COPD and alone was correct in only 66 percent of cases.4 us, a considering this diagnosis (e.g., panic attack).5 management. e use of dyspnoea biomarker panels does not Brain natriuretic peptide (BNP) intubation, and inhalational anaesthesia as needed. congestive cardiac failure, the initial management of sudden systematic approach, comprising of adequate history and appear to improve accuracy beyond clinical assessment and is is used to diagnose heart failure, but it can also be elevated onset of dyspnoea may include therapies directed at both these ABSTRACT diagnostic studies, and provide recommendations for initial physical examination, followed by appropriate investigations focused testing.6, 7 in uid overload secondary to renal failure.
  • Acute Immune Thrombocytopenic Purpura in Children

    Acute Immune Thrombocytopenic Purpura in Children

    Turk J Hematol 2007; 24:41-51 REVIEW ARTICLE © Turkish Society of Hematology Acute immune thrombocytopenic purpura in children Abdul Rehman Sadiq Public School, Bahawalpur, Pakistan [email protected] Received: Sep 12, 2006 • Accepted: Mar 21, 2007 ABSTRACT Immune thrombocytopenic purpura (ITP) in children is usually a benign and self-limiting disorder. It may follow a viral infection or immunization and is caused by an inappropriate response of the immune system. The diagnosis relies on the exclusion of other causes of thrombocytopenia. This paper discusses the differential diagnoses and investigations, especially the importance of bone marrow aspiration. The course of the disease and incidence of intracranial hemorrhage are also discussed. There is substantial discrepancy between published guidelines and between clinicians who like to over-treat. The treatment of the disease ranges from observation to drugs like intrave- nous immunoglobulin, steroids and anti-D to splenectomy. The different modes of treatment are evaluated. The best treatment seems to be observation except in severe cases. Key Words: Thrombocytopenic purpura, bone marrow aspiration, Intravenous immunoglobulin therapy, steroids, anti-D immunoglobulins 41 Rehman A INTRODUCTION There is evidence that enhanced T-helper cell/ Immune thrombocytopenic purpura (ITP) in APC interactions in patients with ITP may play an children is usually a self-limiting disorder. The integral role in IgG antiplatelet autoantibody pro- American Society of Hematology (ASH) in 1996 duction
  • Adasuve, INN-Loxapine

    Adasuve, INN-Loxapine

    ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS 1 1. NAME OF THE MEDICINAL PRODUCT ADASUVE 4.5 mg inhalation powder, pre-dispensed 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each single-dose inhaler contains 5 mg loxapine and delivers 4.5 mg loxapine. 3. PHARMACEUTICAL FORM Inhalation powder, pre-dispensed (inhalation powder). White device with a mouthpiece on one end and a pull-tab protruding from the other end. 4. CLINICAL PARTICULARS 4.1 Therapeutic indications ADASUVE is indicated for the rapid control of mild-to-moderate agitation in adult patients with schizophrenia or bipolar disorder. Patients should receive regular treatment immediately after control of acute agitation symptoms. 4.2 Posology and method of administration ADASUVE should only be administered in a hospital-setting under the supervision of a healthcare professional. Short-acting beta-agonist bronchodilator treatment should be available for treatment of possible severe respiratory side-effects (bronchospasm). Posology The recommended initial dose of ADASUVE is 9.1 mg. A second dose can be given after 2 hours, if necessary. No more than two doses should be administered. A lower dose of 4.5 mg may be given if the 9.1 mg dose was not previously tolerated by the patient or if the physician decides a lower dose is more appropriate. Patient should be observed during the first hour after each dose for signs and symptoms of bronchospasm. Elderly The safety and efficacy of ADASUVE in patients older than 65 years of age have not been established. No data are available. Renal and/or hepatic impairment ADASUVE has not been studied in patients with renal or hepatic impairment.