Anaphylaxis and Epinephrine

I have a personal interest in anaphylaxis and epinephrine. My wife nearly died after being stung by hornets in 2009. Unfortunately, I was on a mission trip to Honduras, and it was up to my 7-year-old daughter to find the EpiPen and help administer the lifesaving injection to my wife. (A video of another patient with anaphylaxis from a wasp sting can be viewed here. It includes the 911 call from my daughter.)     Two major problems occur with anaphylaxis: recognition and management. The recognition problem is related to the very confusing and complex diagnostic criteria that have been established. (Ann Emerg Med 2006;47[4]:373.) I carefully reflected on these criteria, and several years ago simplified the definition for myself and our residents: If two organ systems are involved, then one has met the definition of anaphylaxis.   Adapted from Ann Emerg Med 2006;47[4]:373.   This definition approximates the criteria and the most common presentations of anaphylaxis quite well. It doesn’t exactly fit the isolated reduced blood pressure after exposure to a likely allergen, but that scenario seems to be relatively uncommon and relatively obvious diagnostically. Nevertheless, the presence or absence of hypotension is a critical decision in managing anaphylaxis. Diagnosed anaphylaxis should be divided into another two distinct categories: anaphylaxis without hypotension and anaphylaxis with hypotension. This fork in the road becomes important in managing anaphylaxis with epine...
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