1/3. Bugged.This was a great save. The crew could easily have missed the presentation of anaphylaxis and let the window for treatment with epinephrine slip away. This patient was in anaphylactic shock. There were no signs that supported a traumatic injury, and that, combined with diaphoresis, urticaria and tachycardic central pulse, contributed to the suspicion of anaphylaxis. anaphylaxis is classified as distributive shock. This type of shock is caused by profound systemic vasodilation, and the heart is unable to increase output enough to maintain blood pressure. Other causes of distributive shock include sepsis and spinal cord injury. It is rare to have both hypotension and wheezing in such cases. In an anaphylactic reaction, an allergen, such as a food protein, medication, insect venom or latex, is introduced into the body. The mast cells of the immune system have a protein on their surface called IgE antibodies (immunoglobulin e). The mast cells are filled with histamines [table: see text] and leukotrienes, which are chemical mediators. These are released when the allergen reacts with the IgE antibodies. When these mediators are released, they cause smooth-muscle constriction in the respiratory and gastrointestinal tracts, resulting in wheezing, stridor, nausea, vomiting and diarrhea. They also cause vascular dilation, leading to edema and urticaria. Most patients will present with either profound vascular effect (shock) or wheezing; this is a rather rare presentation of a patient having both. The medication best suited to counteract the effects of these medicators is epinephrine. epinephrine is an alpha- and beta-agonist, acting to constrict the vasculature and dilate the smooth muscles in the bronchial tree. Antihistamines can alleviate symptoms of anaphylaxis, but should only be used in addition to epinephrine, not as a substitute. In life-threatening reactions, epinephrine must be given quickly and in a form that the body can distribute. Use of the subcutaneous route with a solution mixed at 1:1,000 dilution is appropriate in most patients, but if the patient is in profound shock and not perfusing the skin (pale, cold, clammy skin), then a more diluted concentration must be given i.v. at a slow rate (1 cc every minute of the 1:1,000 dilution) until the patient recovers. If i.v. access is delayed or not available, give the 1:1,000 dilution intramuscularly, in the tongue or down the endotracheal tube. Refer to your local protocols for dosage, but the usual dose of epinephrine is 0.3-0.5 mg, or 0.01 mg/kg in a child. There are more than 40 million people in the U.S. with allergic histories that place them at risk for developing anaphylaxis. Each year over 5,000 deaths are attributed to anaphylaxis. The risk of death from anaphylaxis increases with a more rapid onset of signs and symptoms. Up to 25% of patients will experience a biphasic reaction. This means there is a recurrence of symptoms several hours after the initial reaction, and it is prudent to observe patients for a period of time following their initial treatment.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
2/3. life-threatening facial edema due to pine caterpillar mimicking an allergic event.BACKGROUND: Approximately 150 species of lepidoptera have been described as causing damage to human skin. One of these species is the pine processionary caterpillar, which is responsible for dermatitis, contact urticaria, ocular lesions and rarely respiratory signs and anaphylactic reactions through IgE-mediated or non-IgE-mediated mechanisms. We report a pediatric case of severe orofacial edema mimicking an allergic reaction after ingestion of a pine processionary caterpillar; urgent airway intubation was required. CASE REPORT: A 15-month-old boy was sleeping under a pine tree when his mother noted a pine caterpillar on his tongue. Because of rapidly developing facial swelling and respiratory distress, the infant was first taken to a local hospital where he received intravenous dexamethasone and pheniramine hydrogen maleate. On arrival at our emergency department, diffuse swelling and edema involving the tongue, perioral, nasal and perimandibular regions, and neck was noted, requiring urgent orotracheal intubation. There were no findings of anaphylaxis. The results of skin prick tests and specific IgE to common aero- and food allergens were negative. A skin prick test with extract of pine caterpillar was also negative. prednisolone and pheniramine hydrogen maleate were administered for 7 days. The child gradually improved and was successfully extubated 4 days later. CONCLUSION: Although oral contact with a pine processionary caterpillar in the form of ingestion is rare, it may cause significant local reaction and airway compromise mimicking an allergic event. In this situation, early intubation to maintain airway patency is a life-saving measure.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
3/3. Injuries from larval Neuroptera.Bites from larval Neuroptera (lacewings) in australia are recorded. This order of insects is among the most primitive of the higher or holometabolous insects, those with a life-history of complete metamorphoses--namely, from egg to larva to pupa to adult. The mobile instars (larva and adult) live by predation. Larvae have generally long, sharp-pointed jaws, which are used in piercing and sucking prey. One family (Chrysopidae) has larvae with jaws capable of piercing human skin. The larvae seek their prey on leaves of shrubs and trees, and occasionally cause bites to gardeners and others, but as these larvae commonly camouflage themselves with the cast skins of their prey (small insects and mites), as well as other material, such as caterpillar faeces and scraps of vegetable debris, they are mostly not recognised by their human victims. The effects are of immediate local pain with erythema and a local papule, lasting a few hours or at most a day or so. No treatment is required.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |