Customizing anaphylaxis guidelines for emergency medicine.

BACKGROUND: Most episodes of anaphylaxis are managed in emergency medical settings, where the cardinal signs and symptoms often differ from those observed in the allergy clinic. Data suggest that low recognition of anaphylaxis in the emergency setting may relate to inaccurate coding and lack of a standard, practical definition. OBJECTIVE: Develop a simple, consistent definition of anaphylaxis for emergency medicine providers, supported by clinically relevant consensus statements. DISCUSSION: Definitions of anaphylaxis and criteria for diagnosis from current anaphylaxis guidelines were reviewed with regard to their utilization in emergency medical settings. The agreed-upon working definition is: Anaphylaxis is a serious reaction causing a combination of characteristic findings, and which is rapid in onset and may cause death. It is usually due to an allergic reaction but can be non-allergic. The definition is supported by Consensus Statements, each with referenced discussion. For a positive outcome, quick diagnosis and treatment of anaphylaxis are critical. However, even in the emergency setting, the patient may not present with life-threatening symptoms. Because mild initial symptoms can quickly progress to a severe, even fatal, reaction, the first-line treatment for any anaphylaxis episode--regardless of severity--is intramuscular injection of epinephrine into the anterolateral thigh; delaying its administration increases the potential for morbidity and mortality. When a reaction appears as "possible anaphylaxis," it is generally better to err on the side of caution and administer epinephrine. CONCLUSION: We believe that this working definition and the supporting Consensus Statements are a first step to better management of anaphylaxis in the emergency medical setting.

Improved quality of life associated with long-term use of guaifenesin in a patient with chronic obstructive pulmonary disease (COPD) & stable chronic bronchitis: A case report.

We read with interest the recent case reports in this journal on the apparent beneficial effects of long-term, high-dose guaifenesin in patients with chronic respiratory disease. This prompted us to review our own patient database as we also recommend daily guaifenesin to patients who report problems with mucociliary clearance. In our rural primary care practice, we currently have over 20 patients who have taken guaifenesin daily, for more than 3 years as an adjuvant to their prescribed medications for either chronic obstructive pulmonary disease (COPD) and/or stable chronic bronchitis. We report the long-term use of guaifenesin in one such patient with COPD, chronic bronchitis and seasonal allergies who presented with dyspnea and chronic, non-productive cough that impacted his activities of daily living.

Improved quality of life associated with long-term daily use of guaifenesin (Mucinex®) in a patient with chronic rhinosinusitis: a case report.

Chronic rhinosinusitis (CRS) is a common disease, and although not life-threatening, carries a vast symptom and economic burden and is associated with significant impairment in quality of life. We report the rapid improvement of symptoms and quality-of-life following initiation of adjunctive daily oral guaifenesin therapy in a 41-year-old male patient with CRS, who presented to our primary care clinic with recurrent infections, severe sinonasal symptoms, cough and hearing loss. Continued daily use of over-the-counter guaifenesin, for almost 3 years, has broken his cycle of recurrent sinus infections. Given that CRS is the most common reason for ambulatory prescription of antibiotics, the observed reduction in infections may have also helped him to avoid antibiotics, thereby reducing his risk for antibiotic resistance and unnecessary adverse events.

The transtheoretical model and primary care: "The Times They Are A Changin'".

PURPOSE: To identify the transtheoretical model and the five stages of change that assist to bring about behavioral change. A case study is presented to illustrate how the model can be applied by primary care nurse practitioners (NPs) to assist patients toward a healthier lifestyle. DATA SOURCES: Scientific literature, theoretical framework, and case study. CONCLUSIONS: The transtheoretical model has implications in primary care to assist NPs in assessing what stage a patient may be in, offering encouragement to promote a healthier lifestyle change, and reassessing the patient to maintain the desired healthy behavior. IMPLICATIONS FOR PRACTICE: Primary care NPs can use the transtheoretical model to better advance patients into a healthy behavioral change. Documentation of the current stage a patient is in can promote continuity of care among providers, outline specific health promotion initiatives to enhance patient care, and provide documentation during regulatory inspections.