aDepartment of Anaesthesiology and Intensive care, Edouard Herriot University Hospital bDepartment of Clinical Research and Innovation, Hospices Civils de Lyon, Lyon cEmergency Department, Louis Mourier University Hospital, Paris 7 University dDepartment of Internal Medicine, Saint Antoine University Hospital, Paris 6 University, Assistance Publique-Hôpitaux de Paris, Paris eDepartment of Internal Medicine, Grenoble University Hospital, Grenoble-Alpes University, Grenoble fDepartment of Dermatology, Gabriel-Montpied University Hospital, Clermont-Ferrand gDepartment of Internal Medicine, Niort Hospital, Niort hDepartment of Internal Medicine, Archet 1 University Hospital, Nice Sophia-Antipolis University, Nice iDepartment of Medicine, Saint Louis University Hospital, Saint Pierre, Réunion jDepartment of Internal Medicine, Caen University Hospital, Caen kDepartment of Dermatology and Allergology, Grenoble University Hospital, Grenoble lDepartment of Internal Medicine, Timone University Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille mDepartment of Dermatology, Saint Eloi University Hospital, Montpellier nDepartment of Dermatology, Besançon University Hospital, Franche-Comté University, INSERM UMR 1098, Besançon oDepartment of Internal Medicine Toulouse University Hospital, Toulouse University, Toulouse pDepartment of Internal Medicine, Lille University Hospital, Lille University, INSERM U995 Lille, Lille, France.
Eur J Emerg Med. 2017 Oct;24(5):318-325. doi: 10.1097/MEJ.0000000000000446.
Angio-oedema is a transitory, localized, noninflammatory oedema of subcutaneous tissue or mucous. When the oedema affects the mouth, lips, tongue or larynx, it can result in fatal asphyxiation in the absence of specific treatment. Oedema secondary to plasma extravasation is usually mediated by either histamine or bradykinin. As laboratory tests are not available in an emergency setting, the implicated mediator cannot be readily determined. The challenge for the emergency physician is to determine the aetiological type, evaluate severity and initiate adapted treatment by means of a structured approach. A team of experts from the French Reference Centre for Angio-oedema reached a consensus for recommendations for the diagnostic and therapeutic strategy to be adopted by emergency departments faced with angio-oedema of the upper airways in adults. The experts defined 11 important questions. Responses were rated using a two-round Delphi methodology. The 11 recommendations were related to triage on admission, a step-by-step diagnostic protocol, definition of attack severity, discouragement of instrumental examination, prioritization of treatment for severe attacks according to clinical signs and anticipation of access to specific treatments by the hospital. Angio-oedema of the upper airways can be fatal and requires anticipation by the emergency department. A search for the aetiology, an evaluation of clinical symptoms and the availability of the treatments are challenges justifying these recommendations.
血管性水肿是一种短暂的、局部的、无炎症的皮下组织或黏膜水肿。当水肿影响口腔、嘴唇、舌头或喉咙时，如果没有特定的治疗，可能会导致致命的窒息。由血浆外渗引起的水肿通常由组胺或缓激肽介导。由于在紧急情况下无法进行实验室检查，因此无法轻易确定涉及的介质。急诊医生的挑战是通过结构化方法确定病因类型、评估严重程度并启动适应性治疗。来自法国血管性水肿参考中心的一组专家就成人上呼吸道血管性水肿的诊断和治疗策略达成共识。专家们确定了 11 个重要问题。使用两轮 Delphi 方法对回答进行评分。11 项建议与入院时的分诊、逐步诊断方案、发作严重程度的定义、不鼓励仪器检查、根据临床症状对严重发作进行治疗优先级排序以及对特定治疗方法的医院准入进行预测有关。上呼吸道血管性水肿可能是致命的，需要急诊部门进行预测。寻找病因、评估临床症状和治疗方法的可用性是证明这些建议合理的挑战。
