i am just a lowly non peds em doc but have treated many cases of acute allergic reaction that required or benefitted from epi. i have never seen or heard of a delayed reaction and/but have never kept a person for longer than 2 hours observation. i do give a dose of decadron orally and send hope with epipen and h2 blockers.
On Jan 7, 2013, at 11:13 AM, Doc Holiday <[log in to unmask]> wrote:
> This does not sound like a bad case.
> And it has been treated. The epinephrine is no longer in the system and there are no symptoms.
> My tendency is to give 1 oral dose of prednisolone if past histoy suggests severe episodes are possible for the patient AND if the allergen contact has not ceased (e.g. removal of topical allergen). In this case the nuts are still in contact with the patient and there is a history of anaphylaxis, so I'd also have given prednisolone, as was done. Then I'd wait a couple of hours to be sure it's been ingested and retained and at least somewhat absorbed. By "a couple" I won't insist on exactly 120 minutes...
> Then discharge with relevant advice.
> I am not aware of ANY patients who have improved, and been given steroids, and then had significant "rebound".
> Here is a question: When last did anyone here get called back to a steroid-loaded patient they were observing, because of a rebound that would have made the patient return to the ED had he/she been discharged?
> I am aware of 6 being the most favourite number of hours to observe people, but I see no reason to prefer it to 4 or 8. My choice of 2 is to make sure the patient has absorbed a significant dose of prednisolone.
> We don't have any long-acting anti-histamines in our ED. We use chlorpheniramine and I would advise it's use every 4-6 hours IF/AS required. If I discharge the patient at bed-time, I often tell parents to GIVE a dose before sleep, hoping for no disrupted sleep.
> Aware of the benefit of adding H2-b, but it's only rarely required.
> For my ED, by the time such a well patient is seen and then has initial treatment is generally 30-90 minutes from arrival. If I now add even 4 hours of observation, I will have pressure to admit the child or have him/her "breach" the 4-hour target for ED stay. This issue does not DICTATE what we do, but it does force us to look more closely and challenge any traditional reason to cause patients to spend time in the ED... This is how we came to eliminate the ol' automatic "rebound" observation for asthma as well.
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
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For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is: