Knowledge of pediatricians working in emergency sector about anaphylaxis treatment
Main Article Content
Abstract
Introduction: Anaphylaxis is a severe, acute and potentially fatal systemic reaction. It presents several triggers and different mechanisms, however, the acute treatment is the same in all the cases. Objective: To evaluate the knowledge about treatment of anaphylaxis and anaphylactic shock (AS) of pediatricians who works in the pediatric emergency sector. Methods: Cross-sectional study through the use of a multiplechoice questionnaire with 10 questions about the treatment of anaphylaxis and AS. All the emergency room pediatricians of a general pediatric hospital were invited. Results: Fifty of fifty-ne pediatricians agreed to take part of the study. The mean of right answers was 6.32 and median of 7 (minimum 2 and maximum 10). There was an appropriate recognition about the drug of choice to initiate the treatment of anaphylaxis and AS in 96% and 92%, respectively. On the route of adrenaline administration, the adequacy of the answers was 64%. Regarding to adrenaline dose 70% were right, however the recognition of the maximum dose was 44%. When asked about the interval to repeat the adrenaline, 38% responded correctly. About adjuvant therapies to treat AS the score was 74% and 60% when questioned about the drug that prevents biphasic anaphylactic reaction. In relation to the observation time, 54% answered the appropriate period. The right answers about available self-injectable adrenaline presentations were 40%. Conclusion: There were difficulty to recognize the maximum dose, self-injectable adrenaline dose and the correct time to repeat the adrenaline/medication, which increase the risk of overdose and adverse effects.
Downloads
Article Details
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC BY) that allows others to share and adapt the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.References
Sampson HA, Muñoz-Furlong A, Campbell RL, Adkinson NF Jr, Bock SA, Branum A, et al. Second symposium on the definition and management of anaphylaxis: summary report-Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium. J Allergy Clin Immunol. 2006;117(2):391-7. http://dx.doi.org/10.1016 /j.jaci.2005.12.1303
Bernd LAG, Sá AB, Watanabe AS, Castro APM, Solé D, Castro FM, et al. Guia prático para o manejo da anafilaxia. Rev Bras Alerg Imunopatol. 2012;35(2):53-70.
Geller M. As múltiplas faces da anafilaxia: anafilaxia induzida por exercício e anafilaxia idiopática. Braz J Allergy Immunol. 2013;1(1):8-13.http://dx.doi.org/10.5935/2318-5015.20130004
Geller M. Anafilaxia e urticárias físicas. Braz J Allergy Immunol. 2013;1(4):195-201. http://dx.doi.org/10.5935/2318-5015.20130025
Mota I, Pereira AM, Pereira C, Tomaz E, Ferreira MB, Sabino F, et al. Abordagem e registro da anafilaxia em Portugal. Acta Med Port. 2015;28(6):1-10.
Irani AM, Akl EG. Management and Prevention of Anaphylaxis. F1000Res. 2015;4: F1000. http://dx.doi.org/10.12688/f1000 research.7181.1
Carlotti APCP. Choque em crianças. Medicina (Ribeirão Preto). 2012;45(2):197-207. http://dx.doi.org/10.11606/issn.2176-7262.v45i2p197-207
Campbell RL, Li JT, Nicklas RA, Sadosty AT, Bernstein D, Blessing-Moore J, et al. Emergency department diagnosis and treatment of anaphylaxis: a practice parameter. Ann Allergy Asthma Immunol. 2014;113(6):599-608. http://dx.doi.org/10.1016/j.anai.2014.10.007
Pastorino AC, Rizzo MC, Rubini N, Di Gesu RW, Di Gesu GMS, Rosário Filho N, et al. Anafilaxia: tratamento. Projeto Diretrizes. Associação Médica Brasileira e Conselho Federal de Medicina. 2011.
Gonzalez-Perez A, Adonte Z, Vidaurre CF, Rodriquez LA. Anaphylaxis epidemiology in patients with and patients without asthma: a United Kingdom database review. J Allergy Clin Immunol. 2010;125(5):1098-1104. http://dx.doi.org/10.1016/j.jaci.2010.02.009
Kanwar M, Irvin CB, Frank JJ, Weber K, Rosman H. Confusion about epinephrine dosing leading to iatrogenic overdose: a life-threatening problem with a potential solution. Ann Emerg Med. 2010;55(4):341-4.http://dx.doi.org/10.1016/j.annemergmed.2009.11.008
Liew PYL, Craven JA. Adrenaline overdose in pediatric anaphylaxis: a case report. J Med Case Rep. 2017;11:129.http://dx.doi.org/10.1186/s13256-017-1290-7
Manuyakorn W, Benjaponpitak S, Kamchaisatian W, Vilaiyuk S, Sasisakulporn C, Jotikasthira W. Pediatric anaphylaxis: triggers, clinical features, and treatment in a tertiary-care hospital. Asian Pac J Allergy Immunol. 2015;33(4):281-8.http://dx.doi.org/10.12932/AP0610.33.4.2015
Chair EMS, Charlton NP, Epstein JL, Ferguson JD, Jensen JL, MacPherson AI, et al. Part 15: First Aid: 2015 American Heart Association and American Red Cross Guidelines Update for First Aid. Circulation. 2015;132(18 suppl 2):S574-89. http://dx.doi.org/10.1161/ CIR.0000000000000269
Wang CL, Davenport MS, Chinnugounder S, Schopp JG, Kani K, Zaidi S, et al. Errors of epinephrine administration during severe allergic-like contrast reactions: lessons learned from a bi-institutional study using high-fidelity simulation testing. Abdom Imaging. 2014;39(5):1127-33.http://dx.doi.org/10.1007/s00261-014-0141-x
Campbell RL, Bellolio MF, Knutson BD, Bellamkonda VR, Fedko MG, Nestler DM, et al. Epinephrine in anaphylaxis: higher risk of cardiovascular complications and overdose after administration of intravenous bolus epinephrine compared with intramuscular epinephrine. J Allergy Clin Immunol Pract. 2015;3(1):76-80. http://dx.doi.org/ 10.1016/j.jaip.2014.06.007
Posner LS, Camargo Jr CA. Update on the usage and safety of epinephrine auto-injectors, 2017. Drug Healthc Patient Saf. 2017; 9:9-18. http://dx.doi.org/10.2147/DHPS.S121733
Simons FE, Ardusso LRF, Bilò MB, El-Gamal YM, Ledford DK, Ring J, et al. World Allergy Organization guidelines for the assessment and management of anaphylaxis. World Allergy Organ J. 2011;4(2):13-37.http://dx.doi.org/10.1097/WOX.0b013e318211496c
Campbell RL, Bashore CJ, Lee S, Bellamkonda VR, Li JTC, Hagan JB, et al. Predictors of Repeat Epinephrine Administration for Emergency Department Patients with Anaphylaxis. J Allergy Clin Immunol Pract. 2015;3(4):576-84. http://dx.doi.org/10.1016/j.jaip.2015.04.009
Korenblat P, Lundie MJ, Dankner RE, Day JH. A retrospective study of epinephrine administration for anaphylaxis: how many doses are needed? Allergy Asthma Proc. 1999; 20(6):383-6. http://dx.doi.org/10.2500/108854199778251834
Simons FER, Clark S, Camargo CA Jr. Anaphylaxis in the community: learning from the survivors. J Allergy Clin Immunol. 2009;124(2):301-6.http://dx.doi.org/10.1016/j.jaci.2009.03.050
Abrams EM, Singer AG, Lix L, Katz A, Yogendran M, Simons FER. Adherence with epinephrine autoinjector prescriptions in primary care. Allergy Asthma Clin Immunol. 2017;13:46.http://dx.doi.org/10.1186/s13223-017-0218-5
Lieberman P, Nicklas RA, Randolph C, Oppenheimer J, Bernstein D, Bernstein J, et al. Anaphylaxis: a practice parameter update 2015. Ann Allergy Asthma Immunol. 2015;115(5):341-84. http://dx.doi.org/10.1016/j.anai.2015.07.019