C. Gunderson , S. Lopez , K. Lukose , N. Akar-Ghibril
{"title":"美国紧急医疗服务中过敏性休克治疗方案的差异 - 改进的机会","authors":"C. Gunderson , S. Lopez , K. Lukose , N. Akar-Ghibril","doi":"10.1016/j.anai.2024.08.034","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction</h3><div>Across the United States, there are significant inconsistencies in the protocols used by Emergency Medical Services (EMS) in the prehospital treatment of anaphylaxis. These discrepancies include variations in the definition of anaphylaxis as well as treatment recommendations. This study performed an analysis of statewide anaphylaxis protocols to identify gaps in the recognition of anaphylaxis and to provide areas for improvement in prehospital management.</div></div><div><h3>Methods</h3><div>States with mandatory or model state-wide ACLS protocols were included (total of 30). Each allergic reaction and/or anaphylaxis protocol was reviewed – emphasis was placed on the definitions used to identify reactions and treatment algorithms.</div></div><div><h3>Results</h3><div>Of the 30 states, only 50% (15) included gastrointestinal symptoms in the definition of anaphylaxis, and only 40% (12) included neurologic manifestations. 47% (14) used a two-organ system definition. For anaphylactic reactions, 100% (30) of protocols recommended diphenhydramine and epinephrine. 90% (27) recommended albuterol if respiratory symptoms were present, 73% (22) recommended intravenous fluids, and 60% (18) recommended steroids. Epinephrine was the first line recommendation for anaphylaxis in 97% (29) of protocols. 25 states (83%) allowed epinephrine autoinjectors and 17 (57%) provided autoinjectors.</div></div><div><h3>Conclusion</h3><div>Many EMS anaphylaxis protocols are incomplete and/or outdated. Surprisingly, many protocols do not consider gastrointestinal or neurologic manifestations. Additionally, many contain outdated recommendations, including the use of steroids and first-generation antihistamines. Despite the convenience of epinephrine autoinjectors, many protocols do not permit or provide them. Given the frequency of EMS activation for allergic reactions, our communities would benefit from standardized protocols using current evidence-based guidelines for the management of anaphylaxis.</div></div>","PeriodicalId":50773,"journal":{"name":"Annals of Allergy Asthma & Immunology","volume":"133 6","pages":"Page S2"},"PeriodicalIF":5.8000,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"DISCREPANCIES IN ANAPHYLAXIS PROTOCOLS ACROSS EMERGENCY MEDICAL SERVICES IN THE UNITED STATES – OPPORTUNITIES FOR IMPROVEMENT\",\"authors\":\"C. Gunderson , S. Lopez , K. Lukose , N. Akar-Ghibril\",\"doi\":\"10.1016/j.anai.2024.08.034\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Introduction</h3><div>Across the United States, there are significant inconsistencies in the protocols used by Emergency Medical Services (EMS) in the prehospital treatment of anaphylaxis. These discrepancies include variations in the definition of anaphylaxis as well as treatment recommendations. This study performed an analysis of statewide anaphylaxis protocols to identify gaps in the recognition of anaphylaxis and to provide areas for improvement in prehospital management.</div></div><div><h3>Methods</h3><div>States with mandatory or model state-wide ACLS protocols were included (total of 30). Each allergic reaction and/or anaphylaxis protocol was reviewed – emphasis was placed on the definitions used to identify reactions and treatment algorithms.</div></div><div><h3>Results</h3><div>Of the 30 states, only 50% (15) included gastrointestinal symptoms in the definition of anaphylaxis, and only 40% (12) included neurologic manifestations. 47% (14) used a two-organ system definition. For anaphylactic reactions, 100% (30) of protocols recommended diphenhydramine and epinephrine. 90% (27) recommended albuterol if respiratory symptoms were present, 73% (22) recommended intravenous fluids, and 60% (18) recommended steroids. Epinephrine was the first line recommendation for anaphylaxis in 97% (29) of protocols. 25 states (83%) allowed epinephrine autoinjectors and 17 (57%) provided autoinjectors.</div></div><div><h3>Conclusion</h3><div>Many EMS anaphylaxis protocols are incomplete and/or outdated. Surprisingly, many protocols do not consider gastrointestinal or neurologic manifestations. Additionally, many contain outdated recommendations, including the use of steroids and first-generation antihistamines. Despite the convenience of epinephrine autoinjectors, many protocols do not permit or provide them. Given the frequency of EMS activation for allergic reactions, our communities would benefit from standardized protocols using current evidence-based guidelines for the management of anaphylaxis.</div></div>\",\"PeriodicalId\":50773,\"journal\":{\"name\":\"Annals of Allergy Asthma & Immunology\",\"volume\":\"133 6\",\"pages\":\"Page S2\"},\"PeriodicalIF\":5.8000,\"publicationDate\":\"2024-10-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Allergy Asthma & Immunology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1081120624005799\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ALLERGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Allergy Asthma & Immunology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1081120624005799","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ALLERGY","Score":null,"Total":0}
DISCREPANCIES IN ANAPHYLAXIS PROTOCOLS ACROSS EMERGENCY MEDICAL SERVICES IN THE UNITED STATES – OPPORTUNITIES FOR IMPROVEMENT
Introduction
Across the United States, there are significant inconsistencies in the protocols used by Emergency Medical Services (EMS) in the prehospital treatment of anaphylaxis. These discrepancies include variations in the definition of anaphylaxis as well as treatment recommendations. This study performed an analysis of statewide anaphylaxis protocols to identify gaps in the recognition of anaphylaxis and to provide areas for improvement in prehospital management.
Methods
States with mandatory or model state-wide ACLS protocols were included (total of 30). Each allergic reaction and/or anaphylaxis protocol was reviewed – emphasis was placed on the definitions used to identify reactions and treatment algorithms.
Results
Of the 30 states, only 50% (15) included gastrointestinal symptoms in the definition of anaphylaxis, and only 40% (12) included neurologic manifestations. 47% (14) used a two-organ system definition. For anaphylactic reactions, 100% (30) of protocols recommended diphenhydramine and epinephrine. 90% (27) recommended albuterol if respiratory symptoms were present, 73% (22) recommended intravenous fluids, and 60% (18) recommended steroids. Epinephrine was the first line recommendation for anaphylaxis in 97% (29) of protocols. 25 states (83%) allowed epinephrine autoinjectors and 17 (57%) provided autoinjectors.
Conclusion
Many EMS anaphylaxis protocols are incomplete and/or outdated. Surprisingly, many protocols do not consider gastrointestinal or neurologic manifestations. Additionally, many contain outdated recommendations, including the use of steroids and first-generation antihistamines. Despite the convenience of epinephrine autoinjectors, many protocols do not permit or provide them. Given the frequency of EMS activation for allergic reactions, our communities would benefit from standardized protocols using current evidence-based guidelines for the management of anaphylaxis.
期刊介绍：
Annals of Allergy, Asthma & Immunology is a scholarly medical journal published monthly by the American College of Allergy, Asthma & Immunology. The purpose of Annals is to serve as an objective evidence-based forum for the allergy/immunology specialist to keep up to date on current clinical science (both research and practice-based) in the fields of allergy, asthma, and immunology. The emphasis of the journal will be to provide clinical and research information that is readily applicable to both the clinician and the researcher. Each issue of the Annals shall also provide opportunities to participate in accredited continuing medical education activities to enhance overall clinical proficiency.
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