Roberto Pieralli M.D.
Sarà forse stata la cioccolata ? 🤷♂️ La "Routine" che non ha nulla di scontato
Vi volevo raccontare un caso tra tanti che ne capitano ogni santo giorno.
Le Diagnosi in Medicina non sono sempre scontate, la presenza non puo' essere sempre sostituita dal remoto, il contatto e la presenza in loco nel soccorso hanno un ruolo centrale.
Vi racconto un caso di anafilassi, che ricordo ha un ventaglio molto ampio di presentazioni, e che non prevede sempre lo shock e l'ipotensione.
Sarà forse stata la cioccolata ? 🤷♂️
Criterion 1 — Acute onset of an illness (minutes to several hours) involving the skin, mucosal tissue, or both (eg, generalized hives, pruritus or flushing, swollen lips-tongue-uvula) and at least one of the following:
●Respiratory compromise (eg, dyspnea, wheeze/bronchospasm, stridor, reduced peak expiratory flow, hypoxemia)
OR
●Reduced blood pressure (BP) or associated symptoms and signs of end-organ malperfusion (eg, hypotonia [collapse], syncope, incontinence)
Note that skin symptoms and signs are present in up to 90 percent of anaphylactic episodes. This criterion will therefore frequently be helpful in making the diagnosis.
Criterion 2 — Two or more of the following that occur rapidly after exposure to a likely allergen for that patient (minutes to several hours):
●Involvement of the skin-mucosal tissue (eg, generalized hives, itch-flush, swollen lips-tongue-uvula).
●Respiratory compromise (eg, dyspnea, wheeze/bronchospasm, stridor, reduced peak expiratory flow, hypoxemia).
●Reduced BP or associated symptoms and signs of end-organ malperfusion (eg, hypotonia [collapse], syncope, incontinence).
●Persistent gastrointestinal symptoms and signs (eg, crampy abdominal pain, vomiting).
Criterion 2 incorporates gastrointestinal symptoms in addition to skin symptoms, respiratory symptoms, and reduced BP. It is applied to patients with exposure to a substance that is a likely allergen for them.
Criterion 3 — Reduced BP after exposure to a known allergen for that patient (minutes to several hours):
●Reduced BP in adults is defined as a systolic BP of less than 90 mmHg or greater than 30 percent decrease from that person's baseline.
●In infants and children, reduced BP is defined as low systolic BP (age-specific)* or greater than 30 percent decrease in systolic BP.
* Low systolic BP for children is defined as:
•Less than 70 mmHg from 1 month up to 1 year
•Less than (70 mmHg + [2 x age]) from 1 to 10 years
•Less than 90 mmHg from 11 to 17 years
Note that criterion 3 is intended to detect anaphylactic episodes in which only one organ system is involved and is applied to patients who have been exposed to a substance to which they are known to be allergic (for example, hypotension or shock after an insect sting).
