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Clinical Conundrums: How Long Should We Monitor After Giving IM Epinephrine for Anaphylaxis?

RebelEM

How Long Should We Monitor After Giving IM Epinephrine for Anaphylaxis? mg of intramuscular (IM) epinephrine for anaphylaxis. What The Evidence Says: Prompt recognition of anaphylaxis is imperative. Updated Anaphylaxis Guidelines (2020) References Lieberman P. His vital signs are normal. The patient is given 0.5

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REBEL Core Cast 108.0 – Angioedema

RebelEM

These chemicals can recruit other cells, like eosinophils, and may lead to anaphylaxis. 2015; 372(5):418-25. Pro-inflammatory mediators then act on the mucosa and cause angioedema. IgE Independent Reactions Mast cells are activated directly by certain medications (i.e. N Engl J Med. PMID 25629740 Hassen GW et al.

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ToxCard: Crotalid Envenomation Part 2 – CroFab vs. AnaVip: What’s the Difference?

EMDocs

However, in 2015 crotalidae equine immune F(ab’) 2 (ANAVIP®) was approved by the FDA for rattlesnake envenomations, and distribution of this antivenom began in 2018. 1,2 Discussion: F(ab) vs. Table 1: Comparison of F(ab) and F(ab’) 2 antivenoms.

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52 in 52 – #36: Randomized Trial of Three Anticonvulsant Medications for Status Epilepticus

EMDocs

population at large Enrollment was terminated at an interim analysis due to predefined futility criteria that suggested that there was a 1% chance that carrying the trial to completion would demonstrate a most effect or least effective treatment.

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SGEM#188: Icatibant Bites the Dust – For ACE-I Induced Angioedema

The Skeptics' Guide to EM

Though this disorder is routinely treated with medications for anaphylaxis (i.e. A 2015 phase 2 study published in the NEJM (Bas et al) touted the role for icatibant in the treatment of these patients. We covered ACE-I induced angioedema and reviewed the 2015 icatibant study on SGEM#110.

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Vasopressor Nonresponse

Northwestern EM Blog

Anaphylaxis Anaphylaxis may present as hypotension alone. Thus, it may easily be confused with a different form of shock and treated with vasopressors such as norepinephrine and vasopressin, which are not first line for anaphylaxis. Urticaria should prompt consideration of anaphylaxis. California Medicine.

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Review of the ATHOS 3 trial

Northwestern EM Blog

The study was designed as a phase III multicenter randomized placebo control trial taking place across 75 intensive care units in the United States from 2015 to 2017. This data shows us that angiotensin II can make the blood pressure better but I would never let it distract you from the things we know matter in sepsis resuscitation.

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