List Archives

Wed May 23 16:57:15 BST 2007

Ken

1) Peanut allergy is SERIOUS!

2) If such a person is admirtted to an EC they should be triages to the immediate group if there are signs of angioedema or anaphylaxis and the urgent group if not.

3) It can be IgE or IgG mediated, mostly the former, for which the risk of fatal anaphylaxis is the worst outcome.

4) Basic treatment is "Epi-pen"/Adrenaline as for any anaphylaxis, followed by 200mg Hydrocortisone IV and some anti-histamine for later support. There is no "cure", but desensitisation may be possible (contact an allergologist for their opinion on this one)

5) ICU care would be as for any allergy / severe asthma, may include nebulised combivent / adrenaline and other drugs / ventilation and glucose control (ala Van Den Berge).

6) As to the DUTY to the persons involved: none unless the law of the USA allows otherwise or unless you are the patient's usual treating physician. The most you can do is forward this information to the patient or their lawyer. However, I would suggest they get a local Emergency Phycisician and an Allergologist as expert witness rather than (an esteemed) trauma surgeon. :)

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU)
ATLS  instructor and DSTC Cape Town Course Director
Intern program Coordinator: Surgery
M.Med (Emergency Medicine) Executive Committee member
Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064
Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch
PO Box 19063
Tygerberg 7505
Western Cape
South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of KMATTOX at aol.com
Sent: Wednesday, May 23, 2007 5:15 PM
To: trauma-list at trauma.org; ccm-l at ccm-l.org
Subject: Peanut Alergy
I have several questions:

1.    How severe are peanut allergies
2.    What is the duty of an EC that receives such a  patient at their triage 
desk
3.    What causes such allergy
4.    What drugs are best used to treat such a  patient
5.    What is done in an ICU with such a patient who  arrives from the EC 
intubated
6.    If I know the name of the city where this  occurred, the name of the 
hospital, the name of the triage personnel, the name  of the attendant that took 
the patient to the hospital and took the patient out  to the second hospital, 
etc.  What DUTY do I have to these individuals if  they asked me for help in 
preventing this from happening in the future?

k

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Peanut Alergy