List Archives

Thu May 24 04:21:03 BST 2007

Ken,

I agree with all of Blue's comments below. Would like a little more info (what kind of severe distress was he/she displaying) but from what your report this could be an EMTALA violation on several fronts, 1) failure to provide a medical screening exam (MSE) and 2) patient parking (this would depend on what you mean by "put in line").  Under EMTALA the second hospital may have an obligation to report the first hospital's failure to provide an MSE and pressure might be placed on them to do so if they have not already (my guess is they did not).  There could negligence as well but again can not be sure without more info.  Your DUTY at this point is a moral duty.  Would is be possible to reach out to the administration of the offending hospital's ED?  That would be my first move.

Steve

Steve Weinman, RN, CEN, EMT
Deputy Chief
EMS & Special Operations
Somerville Rescue Squad
21 Park Ave.
Somerville, NJ 08876
908-526-4545 (voice/fax)

-----Original Message-----
From: trauma at emergencyunit.com
To: 'Trauma & Critical Care mailing list' <trauma-list at trauma.org>
Sent: Wed, 23 May 2007 11:52 am
Subject: RE: Peanut Alergy

1. This can be true anaphylaxis and thus rapidly fatal.
2. Immediate assessment and prioritised care.
3. The allergy is to the peanut (groundnut) protein mediated (of course) via
gE but also IgG to a lesser extent. I'm not able to retrieve much at
resent but this may be a good starting point:
Ann Allergy Asthma Immunol. 2004 Nov;93(5 Suppl 3):S12-8
   Peanut allergenicity.
        * Scurlock AM,
       * Burks AW.
    Division of Pediatric Allergy and Immunology, Duke University Medical
enter, Durham, North Carolina 27710, USA.
    OBJECTIVE: To provide the reader with a relevant review of the structure
nd allergenicity of the major peanut allergens, while also exploring
redictors of clinical reactivity to peanuts, the natural history of peanut
llergy, and novel therapeutic strategies for peanut hypersensitivity. DATA
OURCES: A PubMed search for the years 1980 to 2004 was performed using the
ollowing search terms: peanut allergy, food allergy, anaphylaxis, peanut
llergen structure, and peanut immunotherapy. STUDY SELECTION: Articles
ighlighting major advances in the study of peanut allergy were selected for
urther review. RESULTS: Peanut allergy is the most serious of the
ypersensitivity reactions to foods due to its persistence and high risk of
evere anaphylaxis. The major peanut allergens and their associated
mmunodominant IgE-binding epitopes have been characterized. Definition of
hese allergens has lead to an increased understanding of the
eanut-specific immunologic response and improved predictors of clinical
eactivity to peanuts. An understanding of these mechanisms is vital for the
ventual development of safe and effective immunotherapy for peanut allergic
atients. Novel therapeutic and diagnostic approaches are being developed
or patients with peanut hypersensitivity. CONCLUSIONS: Improved
nderstanding of the molecular structure of the major peanut allergens and
he peanut-specific immune response has lead to significant diagnostic and
herapeutic advances in the study of peanut allergy.
4. Standard anaphylaxis treatment; I don't think any of the epitope blockers
re yet available.
5. As before; life support as required.
6. Sorry; can't help as that is US specific.
Blueflightmedic.
-----Original Message-----
rom: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of KMATTOX at aol.com Sent: 23 May 2007 16:15
o: trauma-list at trauma.org; ccm-l at ccm-l.org Subject: Peanut Alergy

 am seeking some practical, immulogical, and therapeutic information  
egarding a patient with known severe peanut allergy.  Detail of the  case
ave come 
o me from three different sources.     My  requests will be going to EMTs, 
aramedics, EMS services, ICUs, EC nurses, EC  doctors, ICU doctors,
ospital 
dministrators, and even attorneys if any or all  seek to give discussion.

 patient with a known peanut allergy was taken to a hospital, in the  
ttendance of another trained medical personnel.   A phone call was  made
head of 
ime that the patient was arriving, but upon arrival was put in  line and
ad 
o wait, although in severe distress.   Out of  frustration the patient was 
aken out by the attendant and taken to a second  facility, where immediate 
ntubation and resuscitation was  required.    

 have several questions:

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

************************************** See what's free at
http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2007-May/ttp://www.aol.com. --
rauma-list : TRAUMA.ORG
o change your settings or unsubscribe visit:
http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2007-May/ttp://www.trauma.org/index.php?/community/ --
rauma-list : TRAUMA.ORG
o change your settings or unsubscribe visit:
http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2007-May/ttp://www.trauma.org/index.php?/community/ 

________________________________________________________________________
AOL now offers free email to everyone.  Find out more about what's free from AOL at AOL.com.

List Archives

For your convenience, find the Trauma List Archive Below

Peanut Alergy