1. A Single Centre Experience In Managing Anaphylaxis In The Emergency Department
Iman Nasr1; Joanna Lukawska1,2; Runa Ali1; Ikram Nasr3; Jason Pott1; Tim Harris1
1 Barts Health NHS trust, United Kingdom;
2 King's College London, United Kingdom;
3 Guy's and St Thomas' NHS trust, United Kingdom
Conclusions
Although the immediate management of anaphylaxis was faultless in all of the cases, the aftercare following emergency treatment was inadequate in a significant proportion of patients.
Our suggestions include:
Better documentation -- Departmental teaching particularly at times of staff turnover.
Easy access to Guidelines , for example poster displays in the emergency department.
Tick box proforma in ED to ensure all aspects of emergency care and aftercare are covered, including blood tests (MCT), Epipen education and provision as well as follow up plan.
Provision of leaflets with information on Anaphylaxis support groups and Epipen use and training.
Introduction
Anaphylaxis is an early, sudden and severe life threatening reaction involving multiple systems (airway and/or cardiovascular collapse and bronchospasm, usually associated with skin and mucosal changes). There are approximately 1-3 anaphylactic reactions occurring per 10,000 population per year. NICE has formulated guidelines for the emergency management of anaphylaxis1.
Results
19/241 patients were identified as true anaphylaxis (8%) - 47% were male. Mean adult age 32 years (16-52). 2/19 (10%) were children (21 months and 5 years).
100% received appropriate treatment with Epipen
55% were offered an adrenaline autoinjector on discharge
47% had 1st timed blood sample for mast cell tryptase (MCT) and 16% of had second timed MCT level
11% of patients had evidence of documented information about biphasic anaphylactic reactions.
All children under the age of 16 were admitted under the care of the paediatrics team.
74% were referred or advised to see a specialist allergy service.
Study Aim
To review current practice in the care of adults, young people and children following emergency treatment for suspected anaphylaxis against the recommendations in the NICE guideline.
Methods
We performed a single centre retrospective audit on patients with anaphylaxis who attended the emergency department (ED) at the Royal London Hospital (RLH) between 01/08/2013 to 31/10/13. We reviewed 241 unselected notes of patients who attended emergency department at the RLH.
Figure 1. Cause of death from anaphylaxis
Table 1. Barts Health Emergency Department Allergic Reactions Algorithm
Figure 2. Tryptase level after anaphylaxis
References:
Emergency treatment of anaphylactic reactions - guidelines for healthcare providers; Resuscitation Council UK (January 2008)
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