scholarly journals Diagnosis and management of anaphylaxis

2020 ◽  
Vol 2 (1) ◽  
pp. 64-68
Author(s):  
Melissa Hearrell ◽  
Aikaterini Anagnostou
Keyword(s):  
Health Care Professionals ◽  
Lower Limbs ◽  
Airway Patency ◽  
Clinical Criteria ◽  
Assessment And Treatment ◽  
Management Plans ◽  
Potential Risk Factors ◽  
Risk Patients ◽  
Life Threatening ◽  
Clinical Emergency

Anaphylaxis is a serious allergic reaction that is rapid in onset and may be life threatening. An informal review of the literature was performed in a nonsystematic way for this article. Key published work was identified and included. The incidence and prevalence of anaphylaxis have increased over time. Anaphylaxis is unpredictable and can be the result of various allergic triggers, including food, insect venom, and medication. In children, the most frequent trigger is food. The diagnosis is based on clinical criteria. After confirmation of the relevant allergen trigger, prevention occurs through strict avoidance of the allergen and optimal management of existing comorbidities. Patients with anaphylaxis require immediate assessment and treatment. The management of a patient with anaphylaxis should start with the removal of exposure to the known or suspected trigger, followed by the assessment of the patient’s circulation, airway patency, breathing, and mental status. The administration of epinephrine at a dose of 0.01 mg/kg (1:1000) intramuscularly is the first-line treatment for anaphylaxis, and there are no absolute contraindications to this treatment. The maximum single dose of epinephrine is 0.5 mg and may be repeated after 5‐10 minutes if needed. After administration of epinephrine, patients with anaphylaxis should be placed supine with their lower limbs elevated. They should not be placed in the upright position. Studies of fatal and near-fatal allergic reactions identified potential risk factors for fatalities such as asthma, peanuts and/or tree nuts, and delayed epinephrine use, and provided important information that may help minimize the future risk. Patients and their families need to be well educated on how to manage potential anaphylactic reactions with training in the use of epinephrine autoinjectors and personalized emergency management plans. Health care professionals must be familiar with this clinical emergency and able to respond to anaphylaxis in a timely and appropriate manner.

Gastrointestinal Bleeding in Congenital Bleeding Disorders

2022 ◽  
Author(s):  
Amir Samii ◽  
Mahshaad Norouzi ◽  
Abbas Ahmadi ◽  
Akbar Dorgalaleh
Keyword(s):  
Gastrointestinal Bleeding ◽  
Management Strategies ◽  
Coagulation Factor ◽  
Bleeding Disorders ◽  
Individual Factor ◽  
Threatening Condition ◽  
Potential Risk Factors ◽  
Risk Patients ◽  
Life Threatening ◽  
Management Approaches

AbstractGastrointestinal bleeding (GIB) is serious, intractable, and potentially life-threatening condition. There is considerable heterogeneity in GIB phenotypes among congenital bleeding disorders (CBDs), making GIB difficult to manage. Although GIB is rarely encountered in CBDs, its severity in some patients makes the need for a comprehensive and precise assessment of underlying factors and management approaches imperative. Initial evaluation of GIB begins with assessment of hematological status; GIB should be ruled out in patients with chronic anemia, and in presentations that include hematemesis, hematochezia, or melena. High-risk patients with recurrent GIB require urgent interventions such as replacement therapy for treatment of coagulation factor deficiency (CFD). However, the best management strategy for CFD-related bleeding remains controversial. While several investigations have identified CBDs as potential risk factors for GIB, research has focused on assessing the risks for individual factor deficiencies and other CBDs. This review highlights recent findings on the prevalence, management strategies, and alternative therapies of GIB related to CFDs, and platelet disorders.

scholarly journals A Review of Eating Disorders and Suicide Risk in Adolescence

2005 ◽  
Vol 5 ◽  
pp. 803-811 ◽  
Author(s):  
Ida F. Dancyger ◽  
Victor M. Fornari
Keyword(s):  
Eating Disorders ◽  
Health Care Professionals ◽  
Suicide Risk ◽  
Medical Literature ◽  
The Past ◽  
Epidemiological Surveys ◽  
Assessment And Treatment ◽  
Life Threatening ◽  
Safety Considerations ◽  
Associated Risk Factors

This review examines the literature during the past 10 years about suicide risk and suicide during adolescence and young adulthood of individuals with eating disorders. Epidemiological surveys are summarized, including suicide rates, parasuicidal behaviors, associated risk factors, and comorbid psychopathology. Critical implications for the comprehensive assessment and treatment planning, including safety considerations, are discussed. Two clinical cases of women with long-standing eating disorders are described to highlight both the pragmatic considerations and the complex clinical challenges of working with patients with eating disorders who become suicidal. The potentially life-threatening issues of safety have not received sufficient attention, neither in the medical literature nor by the treating clinicians. All health care professionals who are treating patients with an eating disorder must be keenly aware of the serious risks of suicidal behavior and of suicide in this population.

Behavioral Emergencies and Crises

2010 ◽  
pp. 739-762
Author(s):  
Phillip M. Kleespies ◽  
Justin M. Hill
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
High Risk ◽  
Work Environment ◽  
Emotional Impact ◽  
High Risk Patients ◽  
Risk Patients ◽  
Life Threatening ◽  
Behavioral Emergencies ◽  
And Training

This chapter illustrates the mental health clinician’s relationship with behavioral emergencies. The chapter begins by distinguishing the terms behavioral emergency and behavioral crisis, and underlying themes among all behavioral emergencies are identified. Given that most clinicians will face a behavioral emergency in their careers, the importance of enhancing the process of educating and training practitioners for such situations far beyond the minimal training that currently exists is highlighted. The chapter continues by exploring various aspects of evaluating and managing high-risk patients (i.e., those who exhibit violent tendencies toward themselves or others, and those at risk for victimization). It includes a discussion of the benefits and limitations to estimating life-threatening risk factors and specific protective factors. The chapter concludes by discussing the emotional impact that working with high-risk patients has on clinicians, and an emphasis is placed on the importance of creating a supportive work environment.

scholarly journals Predictive Biomarkers of Oxaliplatin-Induced Peripheral Neurotoxicity

2021 ◽  
Vol 11 (7) ◽  
pp. 669
Author(s):  
Roser Velasco ◽  
Montserrat Alemany ◽  
Macarena Villagrán ◽  
Andreas A. Argyriou
Keyword(s):  
Predictive Biomarkers ◽  
Lower Limbs ◽  
Platinum Compound ◽  
Effective Strategy ◽  
Peripheral Neurotoxicity ◽  
Early Biomarkers ◽  
Increased Risk ◽  
Neurotoxic Effects ◽  
Risk Patients ◽  
Dose Limiting Toxicity

Oxaliplatin (OXA) is a platinum compound primarily used in the treatment of gastrointestinal cancer. OXA-induced peripheral neurotoxicity (OXAIPN) is the major non-hematological dose-limiting toxicity of OXA-based chemotherapy and includes acute transient neurotoxic effects that appear soon after OXA infusion, and chronic non-length dependent sensory neuronopathy symmetrically affecting both upper and lower limbs in a stocking-and-glove distribution. No effective strategy has been established to reverse or treat OXAIPN. Thus, it is necessary to early predict the occurrence of OXAIPN during treatment and possibly modify the OXA-based regimen in patients at high risk as an early diagnosis and intervention may slow down neuropathy progression. However, identifying which patients are more likely to develop OXAIPN is clinically challenging. Several objective and measurable early biomarkers for OXAIPN prediction have been described in recent years, becoming useful for informing clinical decisions about treatment. The purpose of this review is to critically review data on currently available or promising predictors of OXAIPN. Neurological monitoring, according to predictive factors for increased risk of OXAIPN, would allow clinicians to personalize treatment, by monitoring at-risk patients more closely and guide clinicians towards better counseling of patients about neurotoxicity effects of OXA.

scholarly journals 84. T2Candida Panel Use Evaluation: a Quality Improvement Project

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S59-S59
Author(s):  
Erika Reategui Schwarz ◽  
Meenakshi Rana ◽  
Rachel Chasan ◽  
Melissa R Gitman
Keyword(s):  
Invasive Candidiasis ◽  
Retrospective Chart Review ◽  
Blood Cultures ◽  
Negative Group ◽  
Improvement Project ◽  
Positive Group ◽  
Negative Results ◽  
Risk Patients ◽  
Life Threatening ◽  
Antifungal Use

Abstract Background Invasive candidiasis is a life-threatening infection with 40% mortality despite antifungal therapy[1] A retrospective chart review of results from our T2Candida Panels from March 2019 to March 2020 was conducted. We compared demographics, co-morbidities, days of antifungal use, length of stay (LOS) and mortality in patients with positive and negative assays. Results 271 assays were performed, 27 were positive and were compared to 81 negatives. Baseline demographics and co-morbidities were similar in both groups. All patients tested had >1 risk factor for candidemia. 78% were positive for C. albicans/C. tropicalis and 11% positive for C. glabrata/C. krusei and C. parapsilosis respectively. Blood cultures were positive in 8 individuals, of which 5 had a positive assay; among the other 3, one grew C. auris. All species in the T2Candida matched the blood cultures when available. β-D-glucan was positive in 82% of patients with positive T2 results vs 46% in the T2 negative group (p = 0.016). Antifungal administration within the time of assay collection was 54% in the negative group vs 74% in the positive group (p = 0.030). Mean duration of antifungal use were significantly lower in the negative group than the positive group (5.98 vs 17.55 days, p = 0.04). Demographics and Comorbidities Outcomes Cultures Conclusion T2Candida was an effective diagnostic and antimicrobial stewardship tool, leading to testing in high risk patients and reducing unnecessary antifungal use. Additional education is required for improved ordering of concurrent blood cultures. Negative results should be interpreted with caution in suspected invasive candidiasis with consideration for species not included in the panel. Disclosures All Authors: No reported disclosures

scholarly journals A Retrospective Review of Patients with Radiological Missed Fractures in an Emergency Department in Hong Kong

2003 ◽  
Vol 10 (4) ◽  
pp. 215-222 ◽  
Author(s):  
VCH Ng ◽  
FL Lau
Keyword(s):  
Emergency Department ◽  
Management Plan ◽  
Lower Limbs ◽  
X Rays ◽  
Accident And Emergency ◽  
Assessment And Treatment ◽  
Spinal Region ◽  
Accident And Emergency Department ◽  
Clinical Records ◽  
Christian Hospital

Aim To review the clinical spectrum and outcome of radiological missed fractures in the Accident and Emergency Department of United Christian Hospital (UCH) in 2002. Method In UCH, radiologists report all X-Rays taken in the Accident and Emergency Department (AED) within 48 hours. The study period was from 1st January 2002 to 31st December 2002. AED notes, relevant clinical records and all X-rays of patients with suspected missed fractures as reported by radiologists were reviewed for information on clinical features, treatments and outcomes. Results A total of 286 cases of missed fractures were found. Fourteen (4.9%) involved the skull and maxillofacial region, 83 (29.0%) involved the chest region, 53 (18.5%) involved the spinal region, 72 (25.2%) involved the upper limbs and 64 (22.4%) involved the lower limbs. Of these 286 cases, 137 (47.9%) were followed up in AED, 90 (31.5%) were referred to specialist clinics for further management, 26 (9.1%) required admission to hospital for further assessment and treatment, and 33 (11.5%) defaulted follow up. Furthermore, 87 (30.4%) of these 286 missed fractures required a change in management plan: 3 missed fractures required operative intervention (internal fixation) and 84 missed fractures required some form of external immobilisation. This group of patient did not lodge any complaint or claim. Conclusion A&E doctors missed quite a number of fractures that might result in significant morbidity. However, a reporting system by radiologists within 48 hours from discharge can pick up all these missed fractures, and may prevent complaints and litigations.

Pituitary apoplexy following endoscopic sinus surgery

2009 ◽  
Vol 124 (6) ◽  
pp. 677-679 ◽  
Author(s):  
G Fyrmpas ◽  
J Constantinidis ◽  
N Foroglou ◽  
P Selviaridis
Keyword(s):  
Endoscopic Sinus Surgery ◽  
Pituitary Apoplexy ◽  
Symptomatic Improvement ◽  
Sinus Surgery ◽  
Effective Technique ◽  
Pituitary Fossa ◽  
Middle Meatal Antrostomy ◽  
Risk Patients ◽  
Life Threatening ◽  
Life Threatening Event

AbstractObjective:To highlight the possibility of pituitary apoplexy after functional endoscopic sinus surgery for elimination of sinonasal infection, an important preparatory step for safe trans-sphenoidal access to the pituitary fossa.Case report:A 67-year-old man with a known pituitary macroadenoma developed headache, diplopia and reduced vision after endoscopic middle meatal antrostomy and ethmoidectomy for rhinosinusitis with polyps. Magnetic resonance imaging showed pituitary haemorrhage. The patient underwent emergency endoscopic trans-sphenoidal resection of the tumour, with significant symptomatic improvement. Despite mild right eyelid ptosis and persistent diabetes insipidus, the patient resumed normal activities in a few weeks. To our knowledge, this is the first report of pituitary apoplexy after a nasal operation.Conclusion:Pituitary apoplexy is a rare and potentially life-threatening event in high risk patients with pituitary adenomas; it may occur spontaneously or after surgical procedures. Early, combined surgical intervention by rhinologists and neurosurgeons is recommended. The endoscopic trans-sphenoidal approach is a safe and effective technique for the acute management of pituitary apoplexy.

scholarly journals Management of transient loss of consciousness of suspected syncopal cause, after the initial evaluation in the Emergency Department

2016 ◽  
Vol 1 (1) ◽  
Author(s):  
Ivo Casagranda ◽  
Michele Brignole ◽  
Simone Cencetti ◽  
Gianfranco Cervellin ◽  
Giorgio Costantino ◽  
...  
Keyword(s):  
Emergency Department ◽  
Initial Evaluation ◽  
Loss Of Consciousness ◽  
Transient Loss Of Consciousness ◽  
Risk Levels ◽  
Risk Patients ◽  
Life Threatening ◽  
Transient Loss ◽  
Multidisciplinary Group ◽  
Diagnostic Investigations

The recommendations enclosed in the present document have been developed by a group of experts appointed by the <em>Gruppo Multidisciplinare per lo Studio della Sincope</em> (Multidisciplinary Group for the Study of Syncope; GIMSI) and Academy of Emergency Medicine and Care (AcEMC). The aim is to define the diagnostic pathway and the management of patients referred to the Emergency Department (ED) for transient loss of consciousness of suspected syncopal cause, which is still unexplained after the initial evaluation. The risk stratification enables the physician to admit, discharge or monitor shortly the patient in the intensive short-stay Syncope Observation Unit (SOU). There are three risk levels of life-threatening events or serious complications (low, moderate, high). Low risk patients can be discharged, while high risk ones should be monitored and treated properly in case of worsening. Moderate risk patients should undergo clinical and instrumental monitoring in SOU, inside the ED. In all these three cases, patients can be subsequently referred to the Syncope Unit for further diagnostic investigations.

scholarly journals A comparison of surgical pulmonary embolectomy and catheter-directed lysis for life-threatening pulmonary emboli

2019 ◽  
Vol 30 (3) ◽  
pp. 388-393 ◽  
Author(s):  
Amalia A Winters ◽  
Michael J McDaniel ◽  
Jose N Binongo ◽  
Rena C Moon ◽  
Wissam A Jaber ◽  
...  
Keyword(s):  
Regression Models ◽  
Pulmonary Emboli ◽  
Short Term ◽  
Pulmonary Embolectomy ◽  
Treatment Groups ◽  
Catheter Directed Thrombolysis ◽  
Risk Patients ◽  
Life Threatening ◽  
Rv Function

Abstract OBJECTIVES Patients with life-threatening pulmonary emboli (PE) have traditionally been treated with anticoagulation alone, yet emerging data suggest that more aggressive therapy may improve short-term outcomes. The purpose of this study was to compare postoperative outcomes between catheter-directed thrombolysis (CDL) and surgical pulmonary embolectomy (SPE) in the treatment of life-threatening PE. METHODS A retrospective single-centre observational study was conducted for patients who underwent SPE or CDL at a single US academic centre. Preprocedural and postprocedural echocardiographic data were collected. Unadjusted regression models were constructed to assess the significance of the between-group postoperative differences. RESULTS A total of 126 patients suffered a life-threatening PE during the study period [60 SPE (47.6%), 66 CDL 52.4%]. Ten (24.4%) SPE patients and 10 (15.2%) CDL patients had massive PEs marked by preprocedural hypotension. Six (10.0%) SPE patients and 4 (6.0%) CDL patients suffered a preprocedure cardiac arrest (P = 0.41). In-hospital mortality rate was 3.3% (2) for SPE, and 3.0% (2) for CDL (P = 0.99). SPE patients were more likely to require prolonged ventilation (15.0% vs 1.5%, P = 0.01). No significant differences were found in other major complications. At baseline echocardiography, 76.9% of SPE patients and 56.9% of CDL patients had moderate or severe right ventricular (RV) dysfunction. Both treatment groups showed marked and durable improvement in echocardiographic markers of RV function from baseline at midterm follow-up. CONCLUSIONS Both SPE and CDL can be applied to well-selected high-risk patients with low rates of morbidity and mortality. Further research is necessary to delineate which patients would benefit most from either SPE or CDL following a life-threatening PE.

scholarly journals CD47 as a potential biomarker for the early diagnosis of severe COVID-19

2021 ◽  
Author(s):  
Katie-May McLaughlin ◽  
Denisa Bojkova ◽  
Marco Bechtel ◽  
Joshua D. Kandler ◽  
Philipp Reus ◽  
...  
Keyword(s):  
Early Identification ◽  
Myocardial Injury ◽  
Immune Escape ◽  
Kidney Injury ◽  
Model Systems ◽  
Literature Searches ◽  
Potential Biomarker ◽  
Risk Patients ◽  
Life Threatening ◽  
Infected Cells

AbstractThe coronavirus SARS-CoV-2 is the cause of the ongoing COVID-19 pandemic. Most SARS-CoV-2 infections are mild or even asymptomatic. However, a small fraction of infected individuals develops severe, life-threatening disease, which is caused by an uncontrolled immune response resulting in hyperinflammation. Antiviral interventions are only effective prior to the onset of hyperinflammation. Hence, biomarkers are needed for the early identification and treatment of high-risk patients. Here, we show in a range of model systems and data from post mortem samples that SARS-CoV-2 infection results in increased levels of CD47, which is known to mediate immune escape in cancer and virus-infected cells. Systematic literature searches also indicated that known risk factors such as older age and diabetes are associated with increased CD47 levels. High CD47 levels contribute to vascular disease, vasoconstriction, and hypertension, conditions which may predispose SARS-CoV-2-infected individuals to COVID-19-related complications such as pulmonary hypertension, lung fibrosis, myocardial injury, stroke, and acute kidney injury. Hence, CD47 is a candidate biomarker for severe COVID-19. Further research will have to show whether CD47 is a reliable diagnostic marker for the early identification of COVID-19 patients requiring antiviral therapy.

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