Search

• Positive attitudes towards an emergency response communities for anaphylaxis (AERC). • High willingness among physicians to provide advice to join an AERC was observed. • The physicians' opinion about minimum age to join an AERC is 15.45 years. • The EMS mediation is preferred by physicians and potentially lowers their concerns. • This survey findings support the AERC approach for patients at risk of anaphylaxis. Patients at risk of anaphylaxis are required to always carry an adrenaline auto-injector (AAI), as the first line of treatment, but their adherence is low. An Emergency Response Community (ERC) is a social network of patients who can potentially help other patients who find themselves without their medication in an emergency. ERC can be mediated by an Emergency Medical Services (EMS) agency or unmediated to provide direct patient-to-patient immediate first aid. The purpose of this research was to study physicians' attitudes towards anaphylaxis ERC (AERC). A convenience sample of 224 physicians were surveyed using an online questionnaire. Answers were analyzed using ANOVA, t -tests and ordinal regression. Positive attitudes towards an AERC found 88.4% (n = 198) see potential in the ERC and 62.9% (n = 141) think that ERC is excellent and should be implemented immediately. Fewer respondents (6.25%, n = 14) rejected the ERC completely. Respondents showed high willingness to provide patients with solicited or unsolicited advice to join an AERC (78%, n = 175 and 50%, n = 111 respectively). Physicians' opinion about the minimum age to join an AERC is an average of 15.45 years. Leading concerns are 'being left without AAI' (54.5%, n = 122), 'expired AAI' (44.2%, n = 99) and 'wrong AAI administration' (41.1%, n = 92). High support for mediated AERC (79%, n = 177) was found and mediation seems to reduce concerns among the majority (68.3%, n = 153) of respondents. Physicians expressed high support for unmediated AERC. EMS mediation is preferred by the respondents and potentially lowers their concerns. Findings support the AERC approach for patients at risk of anaphylaxis. Patients at risk of anaphylaxis are required to always carry an adrenaline auto-injector, as the first line of treatment, but their adherence is low. An Emergency Response Community (ERC) is a social network of patients who can potentially help other patients who find themselves without their medication in an emergency. ERC can be mediated by an Emergency Medical Services (EMS) agency or unmediated to provide direct patient-to-patient immediate first aid. The purpose of this research was to study physicians' attitudes towards anaphylaxis ERC (AERC). A convenience sample of 224 physicians were surveyed using an online questionnaire. Physicians expressed high support for unmediated AERC and high willingness to provide patients with solicited or unsolicited advice to join an AERC. EMS mediation is preferred by the respondents and potentially lowers their concerns. Leading concerns are 'being left without AAI', 'expired AAI', and 'wrong AAI administration'. [ABSTRACT FROM AUTHOR]

Background: Nontraumatic impaired consciousness is a common issue in emergency departments with a serious but widely variable prognosis. Study Objectives: The aim of this prospective study was to evaluate the ability of systematic combined noncontrast computed tomography (NCCT)/computed tomography angiography (CTA) imaging, firstly to provide a neurologic prognosis and secondly to ensure early detection of basilar artery occlusion (BAO), in unexplained nontraumatic impaired consciousness management. Methods: Combined NCCT/CTA imaging was performed on 65 patients with impaired consciousness and no history of trauma prospectively over 14 months in a single center. Images were assessed based on visual and quantitative criteria. Clinical outcome was assessed using the modified Rankin Scale at 3 months. Statistical analysis aimed to identify the prognostic value of combined NCCT/CTA imaging and its ability for early BAO detection. Results: This study shows that combined NCCT/CTA imaging was a significant predictor of poor neurological outcome, with a positive predictive value of 94.6%. The combination was also crucial for early detection of BAO, given that 42.8% of cases were misdiagnosed with NCCT alone. Basilar artery occlusion represented 10.8% of all unexplained nontraumatic impaired consciousness. Conclusions: Systematic combined NCCT/CTA imaging is an efficient tool for predicting poor neurologic prognosis in cases of unexplained nontraumatic impaired consciousness and is also essential for detecting BAO. [ABSTRACT FROM AUTHOR]

Methods for prognosis assessment and patient management in acute pulmonary embolism (PE) are much debated among physicians. We conducted an online survey to determine physician's attitudes and barriers towards the use of prognostic models when treating patients with acute PE. Physicians members of the French and the European scientific societies for emergency medicine or of a French thrombosis research network were reached by their respective scientific societies and invited to participate via email. The questionnaire was a mixture of close-ended with yes-no or multiple-choice options and a small number of open-ended questions. The survey included 461 respondents. The most commonly used prognostic tools were clinical judgment (36%) and prognostic models (29.5%). Prognostic models were used by 57% of respondents in more than half of all cases and prognostic indicators by 62% in addition to prognostic models. Affiliation group and type of hospital emerged as independent predictors for choosing prognostic models. Many (52%) reported lack of familiarity with the models and reported clinical judgment (60%) or hospital checklists (73%) as being as good as or better than prognostic models. The highest acceptable 30-day mortality rate limit for early discharge or outpatient management was deemed to be 1%, but few patients are discharged early or completely managed on an outpatient basis. This survey provides new information for implementing knowledge translation strategies to improve prognostic risk assessment for acute PE patients, and highlights the need for considering the use of clinical judgment and hospital checklists in future clinical research. • Assessing prognosis in acute pulmonary embolism may help inform clinical management. • Our survey shows physicians mostly rely on prognostic models and clinical judgment. However, they rarely use models and often combined them with other prognostic tools. • Lack of familiarity with the models have an impact on management decisions. Few patients are discharged early or completely managed on an outpatient basis. [ABSTRACT FROM AUTHOR]

Allergens can induce anaphylactic shock and death due to severe hypotension. Potassium channel blockers (K+ ATP) such as glyburide (GLY) induce vasoconstriction. The effect of K+ ATP channel blockers on anaphylactic shock is poorly understood. Objective of the study was to test the hypothesis that GLY reduces hypotension induced in anaphylactic shock and increases survival. Rats were grouped into: G1-N=Naïve; G2-SC=Sensitized-Control; G3-SG=Sensitized-GLY (glyburide 40mg/kg); G4-SE=Sensitized-EPI (epinephrine 10µg/kg). G2 to G4 groups were sensitized with ovalbumin (OVA) and shock was induced by i.v. injection of OVA. Treatments were administered intravenously 5min later. Mean arterial pressure (MAP), heart rate (HR), and mean survival time (MST) were measured for 60min following OVA injection and treatments administration. At the end of the experiment, blood withdrawal was performed to measure plasma levels of histamine, leukotriene B4 (LTB4), prostaglandin E2 (PGE2) and prostaglandin F2 (PGF2). Additionally blood gas (paO2, paCO2, SaO2) and electrolytes (Na+, K+ and Ca++) were measured. MAP was normal in G1-N; severe hypotension, negative inotropic and short MST were observed in G2-SC; normalization of MAP, with lesser negative inotropism and increased MST were observed in G3-SG; full recovery was observed in G4-SE. Histamine level was significantly higher in G2-SC; reduced in G3-SG and G4-SE. PGE2 increased in G3-SG; PGF2 increased in G2-SC and G3-SG. Na+ and Ca++ concentration decreased in sensitized rats but reversed in treated groups, without change in K+ concentration. In conclusion, our data suggest that administration of GLY reduces hypotension and increases survival time in rat anaphylactic shock. [ABSTRACT FROM AUTHOR]