Resuscitation

Impact of the new UK guidelines on the emergency management of anaphylaxis at two hospitals (2024)

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Type of publication:

Conference abstract

Author(s):

*Elshahawy M.; *Kadambi M.; *Inani M.; Hughes D.; Clarke D.; Cooper A.; Goddard S.; Diwakar L.

Citation:

Allergy: European Journal of Allergy and Clinical Immunology. Conference: European Academy of Allergy and Clinical Immunology Hybrid Congress. Virtual. 79(Supplement 113) (pp 328-329), 2024. Date of Publication: 01 Oct 2024.

Abstract:

Background: In 2021, the UK Resuscitation Council made changes to the guidance on the management of acute anaphylaxis. The most significant of these included a) removal of antihistamine (chlorpheniramine) and steroid (hydrocortisone) from the algorithm b) Advise to administer repeated doses of IM adrenaline every 5 minutes until there has been an improvement in breathing and circulation. We carried out an audit to understand how the change in guideline has impacted patient care. Other aspects audited include measurement of serum tryptase and referral to specialist clinic. Method(s): This was a retrospective study using Ambulance Service and hospital notes to assess management of all patients presenting to the accident and emergency department at the university hospital of North Midlands (UHNM) and Shrewsbury and Telford hospitals (SaTH) with anaphylaxis in the years 2018 and 2022. ICD 10 codes were used to identify patients. Result(s): A total of 103 and 109 patients presented in 2018 and 2022 respectively with anaphylaxis. A&E and ambulance notes were available for 100 patients in 2018 (97%) and 103 (95%) patients in 2022. There were no deaths. Patient groups similar in age (range: 1-90 yrs) and gender (60% female) for both years across both sites. Less than half had tryptase measured. A significant number of patients with only skin symptoms were classified as having anaphylaxis. There was a significant reduction in the use of steroids and antihistamines between 2018 and 2022. Use of adrenaline was lower in 2022. Very few patients were referred to specialist clinics in both years, particularly from SaTH hospital. Conclusion(s): Anaphylaxis maybe over diagnosed in the emergency department. There has been some adherence to the new UK guideline for anaphylaxis management. Most patients still do not have serum tryptase checked. Referral rates are low.

DOI: 10.1111/all.16299

Point of View: A Holistic Four-Interface Conceptual Model for Personalizing Shock Resuscitation (2025)

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Type of publication:

Journal article

Author(s):

Rola, Philippe; Kattan, Eduardo; Siuba, Matthew T; Haycock, Korbin; Crager, Sara; Spiegel, Rory; Hockstein, Max; Bhardwaj, Vimal; *Miller, Ashley; Kenny, Jon-Emile; Ospina-Tascon, Gustavo A; Hernandez, Glenn.

Citation:

Journal of Personalized Medicine. 15(5), 2025 May 20.

Abstract:

The resuscitation of a patient in shock is a highly complex endeavor that should go beyond normalizing mean arterial pressure and protocolized fluid loading. We propose a holistic, four-interface conceptual model of shock that we believe can benefit both clinicians at the bedside and researchers. The four circulatory interfaces whose uncoupling results in shock are as follows: the left ventricle to arterial, the arterial to capillary, the capillary to venular, and finally the right ventricle to pulmonary artery. We review the pathophysiology and clinical consequences behind the uncoupling of these interfaces, as well as how to assess them, and propose a strategy for approaching a patient in shock. Bedside assessment of shock may include these critical interfaces in order to avoid hemodynamic incoherence and to focus on microcirculatory restoration rather than simply mean arterial pressure. The purpose of this model is to serve as a mental model for learners as well as a framework for further resuscitation research that incorporates these concepts.

DOI: 10.3390/jpm15050207

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Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS): providing resuscitative care (2020)

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Type of publication:
Journal article

Author(s):
*Kempsell-Smith M.; *Meenan S.

Citation:
Nursing children and young people; 2020 Sep 10;32(5):13-16

Abstract:
Little is understood about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for the COVID-19 pandemic. Furthermore, there is limited literature available and few case studies exploring the observations of colleagues involved in managing patients with COVID-19. Children represent a small sample of the confirmed cases of COVID-19 in the UK but the reasons for this are relatively unknown. Most children are asymptomatic or exhibit mild symptoms from COVID-19 infection. However, a small number have been identified who develop a significant systemic inflammatory response, referred to as paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). PIMS-TS involvespersistent fever and organ dysfunction. PIMS-TS can also share clinical features with other conditions including toxic shock syndrome, septic shock and Kawasaki disease. This article presents a case study to explore the resuscitative care provided to a ten-year-old child with suspected PIMS-TS.

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Human factors: role of cognitive and social skills in clinical practice (2017)

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Type of publication:
Journal article

Author(s):
*Thomas Wood

Citation:
Emergency Nurse; Mar 2017; vol. 24 (no. 10); p. 18-19

Abstract:
Last September, a team from our trust was chosen by the Resuscitation Council UK (RCUK) to represent the UK in a simulation-based cardiopulmonary resuscitation (CPR) competition at the annual European Resuscitation Congress, in Iceland.

Predicting and measuring fluid responsiveness with echocardiography (2016)

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Type of publication:
Journal article

Author(s):
*Miller, Ashley, Mandeville, Justin

Citation:
Echo research and practice, June 2016, vol. 3, no. 2, p. G1

Abstract:
Echocardiography is ideally suited to guide fluid resuscitation in critically ill patients. It can be used to assess fluid responsiveness by looking at the left ventricle, aortic outflow, inferior vena cava and right ventricle. Static measurements and dynamic variables based on heart-lung interactions all combine to predict and measure fluid responsiveness and assess response to intravenous fluid resuscitation. Thorough knowledge of these variables, the physiology behind them and the pitfalls in their use allows the echocardiographer to confidently assess these patients and in combination with clinical judgement manage them appropriately.

Link to full text: http://www.echorespract.com/content/3/2/G1.abstract