EMS World

AUG 2011

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

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Page 50 of 71

CE ARTICLE toms such as localized edema, urticaria (hives), fl ushing, pruritus, cramping and abdominal pain. Localized vasodilation and capillary permeability in the respira- tory tract produce symptoms including wheezing and complaints of mild diffi culty breathing. Anaphylaxis represents the most serious manifestation of a Type 1 hyper- sensitivity reaction. Though the true incidence of anaphylaxis is unknown, a recent study concluded that the life- time prevalence of anaphylaxis is about 1%–2% of the U.S. population as a whole, and another found that 1%–15% of the U.S. population is at risk of experiencing an anaphylactic reaction.2,3 Anaphylaxis is characterized by an acute multiorgan system reaction to an allergen and results in a more global distribution of increased capillary permeability, vasodi- lation, smooth muscle contraction and sensory nerve stimulation compared to a localized allergic reaction. Common organ systems affected include the respi- ratory, cardiovascular, cutaneous, gastro- intestinal and central nervous systems. Signs and symptoms include: • Upper respiratory: nasal conges- tion and itching, rhinorrhea, sneezing, laryngeal edema resulting in stridor, dyspnea, hoarseness and sensation of a “tight throat.” • Lower respiratory: Bronchospasm can result in dyspnea, chest tightness, wheezing, cough, tachypnea. • Cardiovascular: Profound fl uid volume shifts can result in circulatory collapse characterized by weakness, dizziness, near-syncope and syncope. Tachycardia, hypotension and shock can be present in severe anaphylaxis. • Cutaneous (skin): urticaria, fl ushing, pruritis, angioedema, cyanosis. • Gastrointestinal: cramping, abdom- inal pain, nausea, vomiting, diarrhea. • Central nervous: anxiety, appre- hension, confusion, headache (all occur as a result of cerebral hypoperfusion and subsequent hypoxia). MANAGEMENT OF ALLERGIC REACTIONS AND ANAPHYLAXIS A patient with a mild allergic reac- tion that is clearly localized can be treated as a BLS patient. If the resulting urticaria and pruritis prove to be uncom- fortable for the patient, administering an antihistamine such as diphenhydramine via the oral or IM route can improve patient comfort. At the first sign of any clinical manifestation of anaphylaxis, the patient should be considered an ALS patient and immediately adminis- tered 0.3 mL of epinephrine 1:1000 IM. IM administration in the vastus lateralis (thigh) has been shown to result in a more rapid maximum plasma concen- tration of epinephrine than IM or SQ 600 Series Easy-Fold Stretchers JSA-604-S All Junkin Easy-Fold Stretchers come with 2" wide standard, automotive-style patient restraint straps and 18 oz. fungus and rot resistant vinyl covers for long-lasting durability and easy clean-up. Each fold to a compact size for easy storage. JSA-602 JSA-603 PROUDLY MANUFACTURED IN THE USA 888-458-6546 3121 Millers Lane Louisville, KY 40216 Tel: 502-775-8303 Fax: 502-772-0548 For More Information Circle 32 on Reader Service Card See Us at EMS Expo Booth #3924 SAFE T Y APPLIANCE COMPAN Y www.junkinsafety.com For More Information Circle 33 on Reader Service Card EMSWORLD.com | AUGUST 2011 47

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