From the Department of Pediatric Emergency Medicine (GKT), the Department of Pediatrics (Emergency Medicine) (LA, ML), and the Department of Emergency Medicine (DCC), Yale University School of Medicine , New Haven , Connecticut .
Prehosp Emerg Care. 2014 Jan-Mar;18(1):46-51. doi: 10.3109/10903127.2013.825352. Epub 2013 Sep 12.
Anaphylaxis is a life-threatening systemic allergic reaction that occurs after contact with an allergy-causing substance. Timely administration of intramuscular epinephrine is the treatment of choice for controlling symptoms and decreasing fatalities. Our purpose was to investigate the prehospital management of anaphylaxis among patients receiving care in an urban tertiary care pediatric emergency department (PED).
We performed a retrospective chart review from May 2008 to January 2010 of patients 18 years or younger who received care in the PED for anaphylaxis. Data were extracted by one investigator and included demographic information, patient symptoms, past medical history, medications administered (including route and provider), and final disposition.
We reviewed 218 cases of anaphylaxis in 202 children. Mean age of patients was 7.4 years; 56% of patients were male. A total of 214 (98%) manifested symptoms in the skin/mucosal system, 68% had respiratory symptoms, 44% had gastrointestinal symptoms, and 2% had hypotension. Sixty-seven percent had a previous history of allergic reaction and 38% had a history of asthma. Seventy-six percent of the patients presented with anaphylaxis to food products, 8% to medications, 1% to stings, and 16% to unknown allergens. Reactions occurred at home or with family members 87% of the time, and at school 12% of the time. Only 36% of the patients who met criteria for anaphylaxis had epinephrine administered by emergency medical services (EMS). Among 26 patients with anaphylactic reactions at school, 69% received epinephrine by the school nurse. Of the 117 patients with known allergies who were with their parents at the time of anaphylactic reaction, 41% received epinephrine. Thirteen patients were seen by a physician prior to coming to the PED; all received epinephrine at the physician's office. In total, epinephrine was given to 41% (89) of the 218 cases prior to coming to the PED.
Our evaluation revealed low rates of epinephrine administration by EMS providers and parents/patients. Education about anaphylaxis is imperative to encourage earlier administration of epinephrine.
过敏反应是一种危及生命的全身性过敏反应，发生于接触过敏原后。及时给予肌肉内肾上腺素是控制症状和降低死亡率的首选治疗方法。我们的目的是调查在城市三级儿科急诊室（PED）接受治疗的过敏反应患者的院前管理。
我们对 2008 年 5 月至 2010 年 1 月在 PED 接受过敏反应治疗的 18 岁或以下患者进行了回顾性图表审查。一名调查员提取了数据，包括人口统计学信息、患者症状、既往病史、给予的药物（包括途径和提供者）以及最终处置。
我们共审查了 202 名儿童中的 218 例过敏反应病例。患者的平均年龄为 7.4 岁；56%的患者为男性。214 例（98%）患者表现为皮肤/黏膜系统症状，68%有呼吸道症状，44%有胃肠道症状，2%有低血压。67%的患者有过敏反应史，38%有哮喘史。76%的患者对食物产品、8%的药物、1%的叮咬物和 16%的未知过敏原产生过敏反应。87%的过敏反应发生在家中或与家人在一起，12%的过敏反应发生在学校。仅 36%符合过敏反应标准的患者接受了紧急医疗服务（EMS）给予的肾上腺素。在 26 名在学校发生过敏反应的患者中，69%的患者由学校护士给予肾上腺素。在 117 名有已知过敏史的患者中，当他们发生过敏反应时，有 41%的患者接受了肾上腺素。13 名患者在来 PED 之前看过医生；所有患者在医生办公室都接受了肾上腺素治疗。总的来说，在来 PED 之前，有 41%（89 例）的 218 例患者接受了肾上腺素治疗。
我们的评估显示，EMS 提供者和家长/患者给予肾上腺素的比例较低。必须对过敏反应进行教育，以鼓励尽早给予肾上腺素。
