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

IF 5.8 2区医学 Q1 ALLERGY

Annals of Allergy Asthma & Immunology Pub Date : 2024-10-25 DOI:10.1016/j.anai.2024.08.034

C. Gunderson , S. Lopez , K. Lukose , N. Akar-Ghibril

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引用次数: 0

摘要

导言在美国各地，急救医疗服务机构（EMS）在过敏性休克的院前治疗中使用的方案存在很大的不一致。这些差异包括过敏性休克定义和治疗建议的不同。本研究对全州范围内的过敏性休克协议进行了分析，以找出在识别过敏性休克方面存在的差距，并提供院前管理方面需要改进的地方。对每个过敏反应和/或过敏性休克协议都进行了审查--重点放在用于识别反应和治疗算法的定义上。结果在 30 个州中，只有 50% （15 个州）将胃肠道症状纳入过敏性休克的定义，只有 40% （12 个州）将神经系统表现纳入过敏性休克的定义。47%（14 个州）使用了双器官系统的定义。对于过敏性反应，100%（30 份）的方案建议使用苯海拉明和肾上腺素。如果出现呼吸道症状，90%（27 份）的方案建议使用沙丁胺醇，73%（22 份）的方案建议静脉输液，60%（18 份）的方案建议使用类固醇。在 97%（29 份）的方案中，肾上腺素是治疗过敏性休克的一线推荐药物。25 个州（83%）允许使用肾上腺素自动注射器，17 个州（57%）提供自动注射器。令人惊讶的是，许多方案并未考虑胃肠道或神经系统表现。此外，许多方案包含过时的建议，包括使用类固醇和第一代抗组胺药。尽管肾上腺素自动注射器非常方便，但许多方案都不允许或不提供肾上腺素自动注射器。鉴于因过敏反应而启动急救服务的频率很高，我们的社区将受益于使用当前循证指南管理过敏性休克的标准化规程。

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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Many EMS anaphylaxis protocols are incomplete and/or outdated.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.

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来源期刊

Annals of Allergy Asthma & Immunology 医学-过敏

CiteScore

6.50

自引率

6.80%

发文量

437

审稿时长

33 days

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.