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http://mastcelldisorders.wallack.us/yabb/YaBB.pl New Mast Cell Research, Studies, and Trials >> New Mast Cell Research, Studies, and Trials >> Anaphylaxis in the ER http://mastcelldisorders.wallack.us/yabb/YaBB.pl?num=1299939240 Message started by Starflower on 03/12/11 at 02:14:00

Title: Anaphylaxis in the ER
Post by Starflower on 03/12/11 at 02:14:00

There are soooooo many goodies to share from Dr. Castells' new book. Some important statistics from the introduction...

In the US, as of 2007:

- 10% of all emergency room visits were due to anaphylaxis

- Only 19% of those patients received epinephrine (by far the quickest and most effective treatment for anaphylaxis)

- At discharge, only 43% were properly diagnosed with anaphylaxis (makes you wonder what the rest of the diagnoses were!)

- In surveying people who died of "unknown causes," 20% were found to have elevated tryptase levels, which indicates that "anaphylaxis was the likely cause of death"

- In a study of 27 patients who had experienced severe anaphylaxis (marked by loss of blood pressure and cardiovascular collapse), 30% did not have any external symptoms (hives, flushing, angioedema)

What this reinforces to me is just how critical it is to wear a medical ID bracelet, carry my own EpiPens everywhere I go, and maintain an up-to-date emergency binder tailored to my individual needs. In fact, I'm going to add a chapter or two from this book. I wish I could afford to give a copy to all my doctors!

Heather

Title: Re: Anaphylaxis in the ER
Post by peter on 03/12/11 at 09:36:14

WHY suuld patients hace to pay for critical medical info
who controls this info to be able to make money out of it

Title: Re: Anaphylaxis in the ER
Post by Starflower on 03/12/11 at 09:50:47

Academic publishing is a very complicated issue. (I know first-hand... I've published many times). There is a movement to make more of these books and articles publicly available for free on the Internet. However... I don't expect it to happen quickly due to issues such as technology, financing to maintain websites, copyright protections, peer review, how things "count" for tenure, etc.... I guarantee that Dr. Castells (and her co-authors) are not making any money off this book!! They would probably prefer to have it available for free so doctors and patients can really take advantage of the information... but that's just not how it works in the academic world right now. Europe is ahead of the US on this issue.

Heather

Title: Re: Anaphylaxis in the ER
Post by summerfields on 03/18/11 at 03:25:17

.

Quote:

At discharge, only 43% were properly diagnosed with anaphylaxis (makes you wonder what the rest of the diagnoses were!)

Really, I'll bet that a lot of them were called "panic or anxiety attack". That's always been my experience.

Quote:

30% did not have any external symptoms (hives, flushing, angioedema)

I'd like to copy THAT "official" passage (from the source) for my personal medical book, it's so critical for the docs to understand this. I have found article-after-article on the internet that explains we can have serious BP and cardio-vascular anaphylaxis without hives, etc., but too many docs don't know it. (Even at Mayo... cough, cough)

Title: Re: Anaphylaxis in the ER
Post by Starflower on 03/18/11 at 04:11:16

Yes, and the really scary thing is that many of the worst attacks (which unfold very quickly and end with cardiovascular collapse) are actually the LEAST likely to show on the skin. The ER docs could think you're having a heart attack instead of anaphylaxis. It is soooooo important to wear to wear a medical ID bracelet.

Heather

Title: Re: Anaphylaxis in the ER
Post by Riverwn on 03/18/11 at 10:59:44

This must have been the publication they were waiting to finish before releasing their thoughts on the conference and the results of the poll we took.. doesnt that mean we should see those results now?? (hoping)
Ramona

Title: Re: Anaphylaxis in the ER
Post by Starflower on 03/18/11 at 11:29:06

Hmmm... I don't think so. It takes several years to publish a book. The draft was probably finished before we even took that survey ;)

I'm thinking of going to TMS this fall... maybe they'll finally be able to talk about it there???

Heather

Title: Re: Anaphylaxis in the ER
Post by missybean on 03/22/11 at 04:33:47

That is scarey. Last week when I was in the ER with my baby this guy came in and he was all red/beet red and puffy and as he was walking by with the nurse to put him in a room he said I need an epi, and then when they were in the room I heard the nurse say he is having anaphylaxis we need an epi and the other nurse said where are they? I don't know where they are, another minute went by before the doctor came in and I heard the nurse say he needs epi. I was shocked they still hadn't given it to him. I'm not a nurse or doctor but I thought that was scarey they didn't know where the epi was.
Melissa

Title: Re: Anaphylaxis in the ER
Post by Lisa on 03/22/11 at 14:01:44

YIKES!!!!! :o What an awful testimony of horrendous incapacity to deal with and recognize an emergency situation!!!! This should be reported to the AUTHORITIES!!!!! >:(

Title: Re: Anaphylaxis in the ER
Post by Josie on 03/31/11 at 09:30:07

Hi Mel and Lisa ,

yes , it should . All hospitals should carry adrenaline in minijects - these are pre loaded syringes that can be used intravenously or have a needle attached for intramuscular injection . In general terms hospitals do not carry or use epi pens in ED . The mini jects are standard .

The fact the nurses did not know where adrenaline was available needs highlighting. All hospitals in the UK have anaphylaxis kits in the crash carts on top of the minijects for cardiac arrest. I have spent many nights checking the crash cart and replenshing them in my old coronary care ( Heart ICU ). We had 16 adrenaline and extra vials .

He should also should have been in a top bed , called resus here .

Any senior nurse in ED would be as concerned about this is we are .

My epi.s live in a bag on my wrist until I am in an appropriate spot - resus .

I hope you were cared for appropriately .
many hugs

Josie