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1.
Medicine (Baltimore) ; 99(11): e19040, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176031

RESUMO

Traditional high ligation and stripping (THLS) is a routine operation for varicose veins. However, THLS is accompanied with postoperative subcutaneous ecchymosis and pain. In this current study, we aimed to explore the effect of tumescence solution (TS) combined with negative pressure wound therapy (NPWT) on the relief of subcutaneous ecchymosis and pain after THLS of great saphenous vein.A total of 180 patients receiving THLS were enrolled in group A, and 120 patients undergoing THLS and TS combined with NPWT were assigned into group B. The occurrences of subcutaneous ecchymosis and pain were recorded. Moreover, the total area of subcutaneous ecchymosis was estimated by the grid method. Visual analogue scale (VAS) score was used to assess the pain level of both groups.Preoperative characteristics were not significantly different between 2 groups. Postoperative ecchymosis occurred in 112 cases (62.2%) of group A and 41 cases (34.2%) of group B. The area of ecchymosis in group A (66.6 ±â€Š44.5) cm was larger than that in group B (25.2 ±â€Š19.9) cm. The number of patients without obvious pain in group A (57, 31.7%) was significantly less than that in group B (77, 64.2%) after operation. In addition, VAS score in group A (3.1 ±â€Š2.6) was higher than that in group B (2.2 ±â€Š1.9).In conclusion, the application of TS combined with NPWT in THLS can not only alleviate subcutaneous ecchymosis and pain, but also prevent the occurrence of subcutaneous ecchymosis and pain after operation. Therefore, it is conducive to postoperative recovery and is suitable for clinical application.


Assuntos
Equimose/terapia , Epinefrina/uso terapêutico , Tratamento de Ferimentos com Pressão Negativa/métodos , Ropivacaina/uso terapêutico , Veia Safena/cirurgia , Varizes/cirurgia , Adulto , Epinefrina/administração & dosagem , Feminino , Humanos , Masculino , Dor Pós-Operatória/terapia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Ropivacaina/administração & dosagem
2.
Med Clin North Am ; 104(1): 129-143, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31757231

RESUMO

Stinging insect allergy is uncommon but can be life threatening. Diagnosis requires clinical history and confirmative skin or blood testing by an allergist. Baseline serum tryptase level can be used to stratify risk. Treatment is supportive for all reactions except for anaphylaxis, which is treated with intramuscular epinephrine, recumbent posture, and adjunct measures such as IV fluids, and oxygen. Venom immunotherapy is most effective for long-term management in patients with a history of anaphylaxis. Venom immunotherapy rapidly reduces the risk of sting anaphylaxis by up to 98% and maintenance treatment can be stopped after 5 years in most cases.


Assuntos
Anafilaxia/tratamento farmacológico , Epinefrina/uso terapêutico , Hipersensibilidade/tratamento farmacológico , Mordeduras e Picadas de Insetos/complicações , Anafilaxia/etiologia , Animais , Humanos , Hipersensibilidade/etiologia , Imunoterapia/métodos , Peçonhas/uso terapêutico
3.
Medicine (Baltimore) ; 98(45): e17502, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702610

RESUMO

AIM: Our objective is to assess the effects of epinephrine for out of hospital cardiac arrest. BACKGROUND: Cardiac arrest was the most serious medical incidents with an estimated incidence in the United States of 95.7 per 100,000 person years. Though epinephrine improved coronary and cerebral perfusion, improving a return of spontaneous circulation, potentially harmful effects on the heart lead to greater myocardial oxygen demand. Concerns about the effect of epinephrine for out-of-hospital cardiac arrest were controversial and called for a higher argument to determine whether the effects of epinephrine is safe and effective for shor and long terms outcomes. METHOD: Searching databases consist of all kinds of searching tools, such as Medline, the Cochrane Library, Embase, PubMed, etc. All the included studies should meet our demand of this meta-analysis. In the all interest outcomes blow we take the full advantage of STATA to assess, the main measure is Risk Ratio (RR) with 95% confidence, the publication bias are assessed by Egger Test. RESULT: In current systematic review and meta-analysis of randomized trials investigating epinephrine for out of hospital cardiac arrest, we found that epinephrine was associated with a significantly higher likelihood of ROSC (RR = 3.05, I = 23.1%, P = .0001) and survival to hospital discharge (RR = 1.40, I = 36.3%, P = .008) compared with non-adrenaline administration. Conversely, epinephrine did not increase CPC 1 or 2 (RR = 1.15, I = 40.5%, P = .340) and hospital admission (RR = 2.07, I = 88.2%, P = .0001). CONCLUSION: In conclusion, in this systematic review and meta-analysis involving studies, the use of epinephrine resulted in a significantly higher likelihood of survival to hospital discharge and ROSC than the non-epinephrine administration, but, there was no significant between group difference in the rate of a favorable neurologic outcome.


Assuntos
Epinefrina/uso terapêutico , Parada Cardíaca Extra-Hospitalar/tratamento farmacológico , Idoso , Epinefrina/efeitos adversos , Hospitalização , Humanos , Pessoa de Meia-Idade , Razão de Chances , Alta do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
4.
Acta Biochim Pol ; 66(3): 285-290, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31531421

RESUMO

Lignocaine a first amino amide-type local anesthetic, when combined or co-administered with epinephrine, a sympathomimetic amine, allows to administer larger doses for numbing, to decrease bleeding, and to make the numbing effect last longer. The study presented here focuses on measures to prove this activity in patients with abdominal surgery. Liposomal formulations of lignocaine and lignocaine plus epinephrine were prepared by a thin film evaporation method. This formulation was injected successfully as liposomal infusion. Thus prepared liposomes were found to be fit for drug delivery when evaluated as per physicochemical parameters. The smooth, even surfaced liposomes with PDI of 0.298 (p<0.05) were found to be efficient in delivering the drug when tested in-vitro (lignocaine as a single drug was at 93.78%, and from combined dosage lignocaine was at 96.29% with 94.62% of release of epinephrine). The randomized, controlled trial was conducted with a population of children that had undergone abdominal surgery and who were grouped into three groups depending upon the type of formulation they received. The three groups of subjects were first one receiving lignocaine liposomal infusion only; second one with lignocaine plus epinephrine liposomal infusion; the third group served as control and received a saline solution only. The serum Cortisol concentration was found to be the least in Group II when compared to Group I. Similarly, end point measurements such as the cool sensation, warm sensation, hot pain, and the sensory blockade test had indicated the superiority of combination of lignocaine with epinephrine in lowering the pain threshold. The result obtained from the above study has shown that epinephrine markedly enhances the local anesthetic activity of lignocaine.


Assuntos
Anestésicos Locais/uso terapêutico , Epinefrina/uso terapêutico , Lidocaína/uso terapêutico , Manejo da Dor/métodos , Simpatomiméticos/uso terapêutico , Abdome Agudo/cirurgia , Anestésicos Locais/administração & dosagem , Criança , Pré-Escolar , Portadores de Fármacos/química , Combinação de Medicamentos , Composição de Medicamentos/métodos , Sinergismo Farmacológico , Epinefrina/administração & dosagem , Feminino , Humanos , Hidrocortisona/sangue , Lidocaína/administração & dosagem , Lipossomos/química , Masculino , Dor Pós-Operatória/tratamento farmacológico , Tamanho da Partícula , Simpatomiméticos/administração & dosagem
6.
Rev Alerg Mex ; 66 Suppl 2: 1-39, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31443138

RESUMO

Anaphylaxis is a severe allergic reaction with a rapid onset and it is potentially life-threatening. Its clinical manifestations are varied; they may affect the skin, the cardiovascular system, the respiratory system, and the digestive system, among others. The treatment of choice, which is an intra-muscular injection of epinephrine (adrenaline), must be applied promptly. Therefore, being prepared to recognize it properly is of crucial importance. The objective of this clinical practice guide is to improve the knowledge of health professionals about anaphylaxis and, consequently, to optimize the treatment and long-term management of this reaction. This guide is adapted to the peculiarities of Latin America; especially in matters regarding the treatment. The need to introduce epinephrine auto-injectors in countries that don't have them yet is highlighted.


Assuntos
Anafilaxia , Guias de Prática Clínica como Assunto , Agonistas Adrenérgicos/administração & dosagem , Agonistas Adrenérgicos/uso terapêutico , Adulto , Algoritmos , Anafilaxia/diagnóstico , Anafilaxia/epidemiologia , Anafilaxia/etiologia , Anafilaxia/terapia , Reanimação Cardiopulmonar , Criança , Terapia Combinada , Gerenciamento Clínico , Vias de Administração de Medicamentos , Epinefrina/administração & dosagem , Epinefrina/uso terapêutico , Glucagon/administração & dosagem , Glucagon/uso terapêutico , Humanos , Testes Imunológicos , Educação de Pacientes como Assunto , Autoadministração , Vasoconstritores/administração & dosagem , Vasoconstritores/uso terapêutico
7.
Scand J Trauma Resusc Emerg Med ; 27(1): 74, 2019 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-31420058

RESUMO

BACKGROUND: The beneficial effect of epinephrine during resuscitation from out-of-hospital cardiac arrest (OHCA) has been inconclusive, and potential harm has been suggested, particularly in trauma victims. Although no significant improvement in neurological outcomes has been found among resuscitated patients using epinephrine, including trauma patients, the use of epinephrine is recommended in the Advanced Trauma Life Support protocol. Given that the use of vasopressors was reported to be associated with increased mortality in patients with massive bleeding, the undesirable effects of epinephrine during the resuscitation of traumatic OHCA should be elucidated. We hypothesised that resuscitation with epinephrine would increase mortality in patients with OHCA following trauma. METHODS: This study is a post-hoc analysis of a prospective, multicentre, observational study on patients with OHCA between January 2012 and March 2013. We included adult patients with traumatic OHCA who were aged ≥15 years and excluded those with missing survival data. Patient data were divided into epinephrine or no-epinephrine groups based on the use of epinephrine during resuscitation at the hospital. Propensity scores were developed to estimate the probability of being assigned to the epinephrine group using multivariate logistic regression analyses adjusted for known survival predictors. The primary outcome was survival 7 days after injury, which was compared among the two groups after propensity score matching. RESULTS: Of the 1125 adults with traumatic OHCA during the study period, 1030 patients were included in this study. Among them, 822 (79.8%) were resuscitated using epinephrine, and 1.1% (9/822) in the epinephrine group and 5.3% (11/208) in the no-epinephrine group survived 7 days after injury. The use of epinephrine was significantly associated with decreased 7-day survival (odds ratio = 0.20; 95% CI = 0.08-0.48; P < 0.01), and this result was confirmed by propensity score-matching analysis, in which 178 matched pairs were examined (adjusted odds ratio = 0.11; 95% CI = 0.01-0.85; P = 0.02). CONCLUSIONS: The relationship between the use of epinephrine during resuscitation and decreased 7-day survival was found in patients with OHCA following trauma, and the propensity score-matched analyses validated the results. Resuscitation without epinephrine in traumatic OHCA should be further studied in a randomised controlled trial.


Assuntos
Reanimação Cardiopulmonar/métodos , Epinefrina/uso terapêutico , Parada Cardíaca Extra-Hospitalar/mortalidade , Parada Cardíaca Extra-Hospitalar/terapia , Vasoconstritores/uso terapêutico , Adolescente , Adulto , Idoso , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Prospectivos , Ferimentos e Lesões/complicações
8.
Pediatr Clin North Am ; 66(5): 995-1005, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31466687

RESUMO

Anaphylaxis is an acute, potentially life-threatening systemic hypersensitivity reaction. Classically, anaphylaxis is an immunoglobulin (Ig) E-mediated reaction; however, IgG or immune complex complement-related immunologic reactions that lead to degranulation of mast cells can also cause anaphylaxis. Food allergy is the most common cause of anaphylaxis, followed by drugs. Patients with anaphylaxis commonly present with symptoms involving skin or mucous membranes, followed by respiratory and gastrointestinal symptoms. Epinephrine is the drug of choice for treating anaphylaxis. Patients and caregivers should be educated on the use of epinephrine autoinjectors with periodic review of symptoms and emergency action plan for anaphylaxis.


Assuntos
Anafilaxia/diagnóstico , Anafilaxia/tratamento farmacológico , Anafilaxia/etiologia , Epinefrina/uso terapêutico , Adolescente , Criança , Hipersensibilidade a Drogas/complicações , Hipersensibilidade Alimentar/complicações , Humanos
9.
Pak J Pharm Sci ; 32(3): 953-956, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31278705

RESUMO

Adhesive capsulitis is painful condition, associated with gradual loss of active and passive shoulder motion that has a disabling capability. In this study we compared the short term outcome by measuring the mean decrease of pain in adhesive capsulitis using University of California Los-Angeles (UCLA) shoulder rating scale after intra-articular Non-Steroidal Anti Inflammatory Drug (NSAID) Ketorolac and Hyaluronic acid injection. This Randomized controlled trial was carried out using non probability consecutive sampling technique from 1st November 2015 to 30th April 2016. Total 160 patients with adhesive capsulitis for six months' age between 18 to 70 years were taken and randomly divided into two equal groups by computer allocation method. The 80 patients in Group A received Intra-articular (NSAID) Ketorolac injection while patients in Group B were given Intra-articular Hyaluronic acid. Pain score for both the groups were recorded using UCLA shoulder rating scale before treatment and then at follow up after a period of 4 weeks. Out of total 160 cases, 47.5% (n=38) in Group A and 45% (n=36) in Group B were male whereas 52.5% (n=42) in Group A and 55% (n=44) in Group B were females. Most commonly affected age group with 40% (n=32) participants was aged between 51 - 60 years. Mean age of Group A was 37.87±1.027 and in Group B was 45.37±5.743. Interestingly 60% (n=48) of Group A and 55% (n=44) of Group B had involvement of the right shoulder. Pre-treatment UCLA pain score was calculated to be 14.90±4.969 in Group-A and 15.16±5.578 in Group-B. Final post treatment UCLA score was 26.67±2.331 in Group A and 21.72±3.838 in Group B. The mean decrease of pain in Adhesive capsulitis using UCLA rating scale was significantly better in NSAID group as compared to Hyaluronic acid group.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Bursite/tratamento farmacológico , Ácido Hialurônico/uso terapêutico , Cetorolaco/uso terapêutico , Dor Musculoesquelética/tratamento farmacológico , Adolescente , Adulto , Idoso , Anestésicos Locais/uso terapêutico , Anti-Inflamatórios não Esteroides/administração & dosagem , Epinefrina/uso terapêutico , Feminino , Humanos , Ácido Hialurônico/administração & dosagem , Injeções Intra-Articulares , Cetorolaco/administração & dosagem , Lidocaína/uso terapêutico , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Medição da Dor , Ombro/fisiopatologia , Resultado do Tratamento , Adulto Jovem
10.
West J Emerg Med ; 20(4): 587-600, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31316698

RESUMO

Angioedema is defined by non-dependent, non-pitting edema that affects several different sites and is potentially life-threatening due to laryngeal edema. This narrative review provides emergency physicians with a focused overview of the evaluation and management of angioedema. Two primary forms include histamine-mediated and bradykinin-mediated angioedema. Histamine-mediated forms present similarly to anaphylaxis, while bradykinin-mediated angioedema presents with greater face and oropharyngeal involvement and higher risk of progression. Initial evaluation and management should focus on evaluation of the airway, followed by obtaining relevant historical features, including family history, medications, and prior episodes. Histamine-mediated angioedema should be treated with epinephrine intramuscularly, antihistaminergic medications, and steroids. These medications are not effective for bradykinin-mediated forms. Other medications include C1-INH protein replacement, kallikrein inhibitor, and bradykinin receptor antagonists. Evidence is controversial concerning the efficacy of these medications in an acute episode, and airway management is the most important intervention when indicated. Airway intervention may require fiberoptic or video laryngoscopy, with preparation for cricothyrotomy. Disposition is dependent on patient's airway and respiratory status, as well as the sites involved.


Assuntos
Angioedema/etiologia , Angioedema/terapia , Serviço Hospitalar de Emergência , Manuseio das Vias Aéreas , Algoritmos , Anti-Inflamatórios não Esteroides/uso terapêutico , Fatores de Coagulação Sanguínea/uso terapêutico , Bradicinina/análogos & derivados , Bradicinina/metabolismo , Bradicinina/uso terapêutico , Antagonistas de Receptor B2 da Bradicinina/uso terapêutico , Broncodilatadores/uso terapêutico , Epinefrina/uso terapêutico , Glucocorticoides/uso terapêutico , Histamina/metabolismo , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Peptídeos/uso terapêutico , Plasma , Urticária/etiologia
12.
Ann Allergy Asthma Immunol ; 123(3): 256-262, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31228629

RESUMO

BACKGROUND: Despite the importance of prompt epinephrine auto-injector (EAI) treatment during anaphylaxis, proper administration technique is often lacking among patients and caregivers. OBJECTIVE: To compare usability and participant preference of Auvi-Q and EpiPen Jr EAIs in a simulated life-threatening allergic emergency-use scenario. METHODS: In this randomized, crossover, human-factors usability study, untrained adults (18-65 years) were tasked with using 0.15 mg Auvi-Q and EpiPen Jr trainers to simulate epinephrine administration to a child-sized manikin. Only written instructions on the device label and/or device voice instructions were available to participants. Endpoints included completing injection tasks per device instructions (primary endpoint), completing key injection tasks, and participant preference/ratings of devices. Completion of injection tasks were evaluated using a McNemar test for paired dichotomous data. RESULTS: Ninety-six adults were included in study analyses. Significantly more participants completed all injection tasks per device instructions with Auvi-Q (85.4%) vs EpiPen Jr (19.8%; P < .001). Significant differences were also observed for completion of key injection tasks (Auvi -Q, 94.8%; EpiPen Jr, 72.9%; P < .001). No digital/hand injection errors were seen with Auvi-Q, whereas 14 participants (14.6%) would have accidentally received a digital/hand injection with EpiPen Jr (P < .001). Overall, significantly more participants preferred Auvi-Q over EpiPen Jr (91.7% vs 6.3%; P < .001 [2.1% no preference]). Median scores for 8 EAI characteristics were also higher for Auvi-Q vs EpiPen Jr. CONCLUSION: In this study, untrained adults preferred and were more likely to use Auvi-Q correctly vs EpiPen Jr, highlighting the importance of device design for successful epinephrine administration during a life-threatening allergic emergency.


Assuntos
Anafilaxia/prevenção & controle , Epinefrina/uso terapêutico , Injeções Intramusculares/métodos , Adolescente , Adulto , Idoso , Cuidadores , Estudos Cross-Over , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Preferência do Paciente , Autoadministração , Adulto Jovem
13.
Artigo em Chinês | MEDLINE | ID: mdl-31163551

RESUMO

Objective: To evaluate the effect of adrenalin saline local injection on reducing bleeding in endoscopic typeⅠtympanoplasty. Method: A total of 50 patients underwent endoscopic type Ⅰtympanoplasty were prospectively enrolled and were randomly divided into 2 groups. Patients in research group were locally injected 5 ml adrenalin saline with a concentration of 1∶200 000, 15 minutes before operation. And the control group were not injected. Grafts acceptance rates, operation time, blood loss, pre- and pro- operative audiograms were compared between the two groups. Result: Compared with control group, the operative time and blood loss was less in research group. These differences were statistically significant(P<0.05). There was no significant difference in grafts acceptance rate between two groups (P>0.05). After surgery, mean air conduction threshold was increased and the air-bone gaps was decreased in both groups,and no statistical significant deference was found between the two groups(P>0.05). Conclusion: Before endoscopic type I tympanoplasty, adrenalin saline local injection can reduce blood loss significantly. This allows better operative view and experience for surgeons and less surgery damage to patients.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Epinefrina/uso terapêutico , Miringoplastia , Timpanoplastia , Endoscopia , Humanos , Injeções , Duração da Cirurgia , Resultado do Tratamento
14.
J Endod ; 45(8): 970-976, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31160080

RESUMO

INTRODUCTION: Bleeding control is an important aspect in endodontic surgery. Two hemostatic techniques were compared with regard to their efficacy to bleeding control in endodontic surgery. METHODS: A randomized, 2-arm, parallel pilot study involving 30 patients with periradicular lesions was performed including the following hemostatic agents: polytetrafluoroethylene strips as an adjunct to epinephrine-impregnated gauze (test group, n = 15) and aluminum chloride (control, n = 15). Bleeding control was independently assessed by the surgeon and 2 blinded observers before and after application of the hemostatic agent. Bleeding control was classified either as adequate (complete bleeding control) or inadequate (incomplete bleeding control). RESULTS: Hemostasis in both groups proved similar. Simple binary logistic regression analysis failed to identify variables affecting bleeding control. Only the height of the keratinized mucosa band (≥2 mm) suggested a risk reduction for an inadequate bleeding control up to 79% (odds ratio = 0.21, P > .05). CONCLUSIONS: No differences in the efficacy of bleeding control were observed between polytetrafluoroethylene strips as an adjunct to epinephrine-impregnated gauze and aluminum chloride.


Assuntos
Cloreto de Alumínio , Implantação Dentária Endo-Óssea , Epinefrina , Hemostáticos , Cloreto de Alumínio/uso terapêutico , Epinefrina/uso terapêutico , Técnicas Hemostáticas , Hemostáticos/uso terapêutico , Humanos , Projetos Piloto , Politetrafluoretileno
15.
Medicine (Baltimore) ; 98(23): e15996, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169740

RESUMO

Drug-induced anaphylaxis (DIA) is a highly paradoxical disorder involving a fatal response to medicines prescribed for therapeutic purposes. This study aimed to improve the awareness on DIA and to prevent errors through an analysis of lawsuit judgments.Sentenced judgments involving DIA from 1998 to 2017 using the database of the Korean Supreme Court Judgment System were collected. General characteristics, results, and recognized negligence of DIA litigation cases were analyzed.Of 27 lawsuit cases included, antibiotics (n = 6, 22.2%), radiocontrast media (n = 6, 22.2%), and non-steroidal anti-inflammatory drugs (n = 5, 18.5%) were the most common drugs that had caused DIA. Cardiac arrest was reported in 23 cases (85.2%). The median time interval from drug administration to diagnosis and from diagnosis to cardiac arrest were 7 (interquartile range, IQR = 0-35) and 5 minutes (IQR = 0-33), respectively, suggesting insufficient time to cope with anaphylaxis. Consequently, either death (n = 18, 66.7%) or ischemic brain injury (n = 9, 33.3%) occurred in all cases. Violation of duty of care was recognized in 19 cases (70.4%) with median awarded amount of $106,060 (IQR = $70,296-$168,363). The recognized negligence included inadequate observation after drug administration (n = 6), delayed or missed epinephrine administration (n = 6), ignoring a history of allergy or drug hypersensitivity (n = 6), and prescription error (n = 5).It is necessary to improve the awareness on DIA, because making a trivial error in any process of history taking, drug prescription and administration, observation, and/or emergency treatment may have fatal consequences that can lead to indemnity.


Assuntos
Anafilaxia/induzido quimicamente , Hipersensibilidade a Drogas/complicações , Epinefrina/uso terapêutico , Imperícia/estatística & dados numéricos , Anafilaxia/tratamento farmacológico , Hipersensibilidade a Drogas/tratamento farmacológico , Humanos , República da Coreia
16.
Pediatr Emerg Med Pract ; 16(6): e1-e2, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31157970

RESUMO

Anaphylaxis is a time-sensitive, clinical diagnosis that is often misdiagnosed because the presenting signs and symptoms are similar to those of other disease processes. This issue reviews the criteria for diagnosing a pediatric patient with anaphylaxis and offers evidence-based recommendations for first- and second-line treatment, including the use of epinephrine, antihistamines, and corticosteroids. Guidance is also provided for the appropriate disposition of patients with anaphylaxis, including prescribing epinephrine autoinjectors and offering training on how to use them, educating patients and families on avoidance of known offending allergens, and referring the patient to a specialist in allergy and immunology. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice.]


Assuntos
Anafilaxia/diagnóstico , Anafilaxia/terapia , Anafilaxia/etiologia , Broncodilatadores/uso terapêutico , Criança , Procedimentos Clínicos , Diagnóstico Diferencial , Diagnóstico Precoce , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Epinefrina/uso terapêutico , Oxigenação por Membrana Extracorpórea , Humanos , Anamnese , Exame Físico , Fatores de Risco , Vasopressinas/uso terapêutico
17.
Pediatr Emerg Med Pract ; 16(6): 1-24, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31124642

RESUMO

Anaphylaxis is a time-sensitive, clinical diagnosis that is often misdiagnosed because the presenting signs and symptoms are similar to those of other disease processes. This issue reviews the criteria for diagnosing a pediatric patient with anaphylaxis and offers evidence-based recommendations for first- and second-line treatment, including the use of epinephrine, antihistamines, and corticosteroids. Guidance is also provided for the appropriate disposition of patients with anaphylaxis, including prescribing epinephrine autoinjectors and offering training on how to use them, educating patients and families on avoidance of known offending allergens, and referring the patient to a specialist in allergy and immunology.


Assuntos
Anafilaxia/diagnóstico , Manuseio das Vias Aéreas/métodos , Anafilaxia/terapia , Criança , Diagnóstico Diferencial , Epinefrina/uso terapêutico , Glucocorticoides/uso terapêutico , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Guias de Prática Clínica como Assunto
18.
Breast J ; 25(4): 631-637, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31087471

RESUMO

BACKGROUND: Postoperative pain remains a major challenge following immediate breast reconstruction with 40% of patients experiencing acute pain and up to 60% developing chronic pain. Paravertebral blocks (PVB's) have emerged as a promising adjunct to standard analgesic protocols. The aim of this study was to assess the utility of PVB's in immediate breast reconstruction following mastectomy. METHODS: A retrospective review of patients undergoing immediate breast reconstruction following mastectomy was performed. The primary outcome was postoperative pain measured by total oral morphine equivalent usage and self reported pain scores and secondary outcomes were length of stay in the PACU, complications, and OR delay. RESULTS: Of 298 patients undergoing immediate breast reconstruction, 112(38%) underwent standard analgesic protocols and 186(62%) underwent PVB in addition to the standard protocol. PVB's were associated with reductions in average postoperative pain scores (2.8 vs 3.3, P = 0.002), total opiate consumption (52 units vs 63 units, P = 0.038) and time spent in the PACU 92 vs 142 minutes, P = 0.0228) compared to patients who had general anesthesia alone. The overall complication rate was 3.7% (7/186 patients), all which were minor complications such as headache, bloody tap, vasovagal episode and temporary weakness. The use of PVBs delayed the OR start time on average by 15 minutes (34 vs 49 minutes). CONCLUSIONS: The present study offers one of the largest retrospective cohort studies to date evaluating the utility of PVB's in immediate breast reconstruction following mastectomy. We demonstrate that, PVB's in immediate breast reconstruction are associated with reductions in postoperative pain, narcotic usage and length of stay in PACU, but are associated with delays to the start time of the case. Anesthesiologists, plastic surgeons and hospital administrators must continue to work together to ensure this important and necessary service is administered in an efficient and cost effective manner.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/efeitos adversos , Mastectomia/efeitos adversos , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Analgésicos Opioides/uso terapêutico , Anestesia Geral/métodos , Raquianestesia/métodos , Epinefrina/uso terapêutico , Feminino , Humanos , Tempo de Internação , Mamoplastia/métodos , Mastectomia/métodos , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Cuidados Pré-Operatórios , Estudos Retrospectivos , Ropivacaina/uso terapêutico
19.
Rev Chil Pediatr ; 90(1): 44-51, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31095218

RESUMO

INTRODUCTION: Anaphylaxis is an emergency condition. According to the latest international guide lines, early recognition and treatment with intramuscular epinephrine are associated with increased survival. OBJECTIVE: To determine the level of knowledge of pediatricians in a tertiary Pediatric Hos pital about the diagnostic criteria and treatment of anaphylaxis. MATERIAL AND METHOD: A cross-sec tional descriptive study was conducted, designing, applying, and validating an anonymous survey to physicians with complete residency in pediatrics who are on call at a third level hospital. The statisti cal analysis was made using the SPSS v.21 software, presenting measures of central tendency (median, range, and frequency table) and Chi-square test for comparison. A value of p < 0.05 was considered significant. RESULTS: 71 physicians completed the survey with a median of three years after the end of residency.35% of them identified all clinical criteria, 99% (70) indicated epinephrine, 73% chose the intramuscular route, and 55% indicated the correct dose. Only 48% of responders chose the dose and administration route correctly. In general, 21% recognized anaphylaxis and used epinephrine correctly. Physicians with less than five years of experience performed better in the intramuscular administration of epinephrine (83% vs 52% p = 0.005) and in the detection of gastrointestinal symp toms (60% vs 35% p = 0.043). CONCLUSIONS: There are difficulties in the identification and proper management of anaphylaxis by pediatricians of a tertiary Pediatric Hospital in a theoretical clinical setting. Although most of pediatricians chose epinephrine as a first-line drug, half of them did not indicate it correctly, and only one-third recognized anaphylaxis in all scenarios.


Assuntos
Anafilaxia/diagnóstico , Anafilaxia/tratamento farmacológico , Competência Clínica/estatística & dados numéricos , Epinefrina/uso terapêutico , Fidelidade a Diretrizes/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Simpatomiméticos/uso terapêutico , Argentina , Criança , Estudos Transversais , Emergências , Pesquisas sobre Serviços de Saúde , Hospitais Pediátricos , Humanos , Injeções Intramusculares , Pediatras/normas , Pediatras/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas
20.
J Korean Med Sci ; 34(13): e106, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30950251

RESUMO

BACKGROUND: Anaphylaxis is increasing in young children. The aim of the present study was to analyze the clinical characteristics of anaphylaxis in Korean infants, with a focus on food triggers. METHODS: The study analyzed the medical records of infants aged 0 to 2 years old who had been diagnosed with anaphylaxis in 23 secondary or tertiary hospitals in Korea. RESULTS: We identified 363 cases of infantile anaphylaxis (66.9% male). Cutaneous symptoms were most prevalent (98.6%), followed by respiratory (83.2%), gastrointestinal (29.8%), and neurologic (11.6%) symptoms. Cardiovascular symptoms were noted in 7.7% of the cases. Most of the cases of anaphylaxis (338; 93.1%) were induced by foods. The most common trigger food was cow's milk and cow's milk products (43.8%), followed by hen's eggs (21.9%), walnuts (8.3%), wheat (7.7%), peanuts (4.8%), other nuts (3.0%), and fish (2.1%). In cow's milk-induced anaphylaxis cases, more than half the cases had cow's milk specific immunoglobulin E (sIgE) levels that were lower than the diagnostic decision points (DDPs), which is 5 kUA/L for those under the age of 1 and 15 kUA/L for those over the age of 1. In anaphylaxis induced by hen's egg, most of the cases (91.8%) had hen's egg sIgE levels that were higher than the DDP, which is 2 kUA/L for those under the age of 2 and 7 kUA/L for those over the age of 2. Of the infantile anaphylaxis cases, 46.8% had been treated with epinephrine, and 25.1% had been prescribed an epinephrine auto-injector. CONCLUSION: Cow's milk is the most frequent trigger food of anaphylaxis in Korean infants. However, we found no significant correlation between the sIgE level and clinical severity. Education is required regarding the importance of epinephrine as the first line therapy for anaphylaxis and on properly prescribing epinephrine for infants with a history of anaphylaxis.


Assuntos
Anafilaxia/diagnóstico , Alérgenos/imunologia , Anafilaxia/tratamento farmacológico , Anafilaxia/epidemiologia , Anafilaxia/imunologia , Animais , Broncodilatadores/uso terapêutico , Pré-Escolar , Hipersensibilidade a Ovo/diagnóstico , Hipersensibilidade a Ovo/tratamento farmacológico , Hipersensibilidade a Ovo/epidemiologia , Epinefrina/uso terapêutico , Feminino , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Imunoglobulina E/sangue , Lactente , Recém-Nascido , Masculino , Leite/imunologia , Hipersensibilidade a Leite/diagnóstico , Hipersensibilidade a Leite/tratamento farmacológico , Hipersensibilidade a Leite/epidemiologia , República da Coreia/epidemiologia , Estudos Retrospectivos
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