CEPA Has Protocol on How Anaphylaxis Handled in Canadian Hospitals

Posted on: Fri, 04/11/2003 - 11:44am
Anonymous's picture
Anonymous (not verified)

Another PA.com member was doing some research re how anaphylaxis is viewed upon arrival in the emergency room of Canadian hospitals and came up with this. I thought it was valuable information for us to know and so I am posting it on his/her behalf:-

The Canadian Association of Emergency Physicians

Posted on: Sat, 04/12/2003 - 1:30am
darthcleo's picture
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I'm not sure if we're reading the same things, cause anaphylaxis is listed in Level I, not level II
Quote:
Severe Respiratory Distress: There are many causes for respiratory distress but benign reasons can only be diagnosed by exclusion. Serious intracranial events, pneumothorax, near death asthma (unable to speak, cyanosis, lethargic/confused, tachycardia/bradycardia, O2 sat <90%) COPD exacerbations, CHF, [b]anaphylaxis[/b] and severe metabolic disturbances (renal failure, Diabetic Keto acidosis). These patients require rapid assessment of the ABC

Posted on: Sat, 04/12/2003 - 1:56am
Corvallis Mom's picture
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Joined: 05/22/2001 - 09:00

My understanding from our allergists is that you can die from cardiac involvment alone- without respiratory distress.
We have fought this problem all too often- in little children ER staff have to be willing to take parents' word on "altered mental state" and all too often, they don't.
How much trouble is it to check blood pressure during triage, anyway? [img]http://uumor.pair.com/nutalle2/peanutallergy/rolleyes.gif[/img]

Posted on: Sat, 04/12/2003 - 1:58am
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Also note that level I is called "ressucitation", not "may possibly die".
Level I is reserved for the cases where the person is actually dying *now*. Cardiac arrest, total respiratory arrest (where anaphylaxis is also listed) Those are the cases where doctors are pulled away from other patients, where even 30 seconds make a life/death difference.
If you go to a hospital in such an advance state of anaphylaxis that you're no longer breathing (not laboured breathing), you will be classified at Level 1. It's for very extreme cases.
All the time I went to St Justine Hospital (a hospital that has its emergency room totally overcrowded), I think I saw one Level I case. The times I went for my asthmatic son, we were classified level II, and waited less than 5 minutes for a doctor. Level IV patients can wait for over 12 hours, just to give you an idea.
As a youngster, I had a doctor pulled away from me for a level I case, it was a nasty motorcycle accident and the young man did die on the operating table while I waited for my sutures. I was 8 and I still remember it.
[This message has been edited by darthcleo (edited April 12, 2003).]

Posted on: Sat, 04/12/2003 - 2:21am
Anonymous's picture
Anonymous (not verified)

I would have thought that anaphylaxis, because it can become more serious at any given moment would be considered Level 1. However, I was wondering what Level people having asthma attacks were assessed at as well, as this does seem to factor into things somewhat.
I have had to take Jesse twice to the hospital for anaphylaxis. His first visit was the time where he almost died. We were seen right away by the doctor. This was at a hospital where the wait in emerg could be up to four hours. I don't know if it's because his anaphylaxis was so far progressed (he had every symptom but loss of consciousness) and the E.R. doctor that night just happened to "get it" but we were taken in right away. He was administered another Epi-pen right away and an I.V. was put in his arm.
We then went from emerg to intensive care where we were required to stay the night and only allowed to leave after a doctor had said it was okay (and with another Epi-pen prescription and 5 days at least worth of Pedi-Pred).
The last time I took Jesse was in December month. This anaphylactic reaction was quite different than his previous two. My DH called the hospital ahead of time to let them know that we were coming. Even though there were no people in the waiting room, we were seen right away by the triage nurse. However, I believe it took up to 40 minutes or more for us to finally be seen by the doctor. I had my Epi-pen in my hand the whole time ready to administer if the doctor didn't get there. I did speak with a nurse and because Jesse did not have respiratory difficulties (that would be noted in the protocol above), they felt he could wait to see the doctor.
This was at an emergency room where I have had to wait up to six hours to be seen.
I'm sorry, I do believe anaphylaxis should be treated as Level 1. This was my son's third anaphylactic reaction. Again, as pointed out the the difficulties with the protocol, what if it is someone's first anaphylactic reaction and they don't even really know what they're dealing with (the parents) and don't have an Epi-pen?
I also understand the overcrowding of hospital emergency rooms, especially since living in small town Ontario where people do not have family doctors or you have to go to emerg when the doctor's office closes (I guess that would be true anywhere). Here, in Belleville, a great number of people don't even have family doctors (i.e., we don't) and family doctors aren't taking people's names on lists to get in even so when you do have a problem you either go to the two walk-in clinics in town or you go to emerg.
Our emergency room here is currently dealing with things that a family doctor *should* be dealing with (i.e., me with a sinus infection a couple of weeks ago) and I understand how difficult and draining this must be on hospital personnel.
However, regardless, I do feel anaphylaxis should be a Level 1.
Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
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Posted on: Sat, 04/12/2003 - 9:58am
darthcleo's picture
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Quote:Originally posted by Cindy Spowart Cook:
[b]I would have thought that anaphylaxis, because it can become more serious at any given moment would be considered Level 1. [/b]
That's the point. It *COULD* become more serious. And when/if it does, then it becomes level 1. Otherwise it's level 2.
I really don't see anything wrong with this. Level 1 is *RESSUSCITATE* , level 2 is everything that can degenerate quickly into ressuscitate mode, but isn't quite there yet.
There needs to be a level that is for *very* prompt reactions from doctors. Even more than prompt. It's pulling a doctor away from an asthma patient, or a teenager with a botched abortion, or any other horror story here. At Level 1, death is within minutes, or seconds even, not within 15 minutes.
Take two kids taken to the ER, both in anaphylactic reactions. One has difficulties breating and is spaced out, the other one has *stopped* breathing and is completely unresponsive. Triage needs a way to show the difference. The more advanced anaphylaxis will be a level 1, the less a level 2.

Posted on: Sat, 04/12/2003 - 10:03am
Anonymous's picture
Anonymous (not verified)

darthcleo, I understand what you're saying. However, I believe is an asthma patient is treated as a Level 1 that an anaphylactic patient *should* be as well.
I understand that there are differences in anaphylactic reaction, as I posted above with Jesse's two very different reactions (and the two very different ways they were received at the E.R.). I still feel, however, that anaphylaxis should be considered Level 1 regardless.
Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
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Posted on: Sat, 04/12/2003 - 10:17am
darthcleo's picture
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Joined: 11/08/2000 - 09:00

As an asthma patient, my son was always a level 2.
Even within asthma, there are levels.
In the document listed above, asthma and anaphylaxis are both level 2. Asthma is listed as no.11, anaphylaxis as no.14 but I think there's a problem with no.13...
Near death asthma is level 1 though. So is advanced anaphylaxis.
[This message has been edited by darthcleo (edited April 12, 2003).]

Posted on: Sat, 04/12/2003 - 12:44pm
Anonymous's picture
Anonymous (not verified)

darthcleo, you have been making sense to me since you started to respond in this thread (believe it or not) but your last post really did clarify it for me.
However, regardless of what the protocol says and what assessment level asthma or anaphylaxis are treated at (Level 1 or Level II), what do you think about this protocol?
Again, I have to say I believe anaphylaxis *should* be at Level 1. I also believe the same for asthma attacks.
Best wishes! [img]http://uumor.pair.com/nutalle2/peanutallergy/smile.gif[/img]
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Posted on: Sat, 04/12/2003 - 12:48pm
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Joined: 09/23/2002 - 09:00

darthcleo,
Thanks for taking what looked like a considerable portion of your time. Thanks for the effort.
MommaBear
PS........... Oh, would you look at that!!!! (searching desperately for clock) "Merlot" time! [img]http://uumor.pair.com/nutalle2/peanutallergy/biggrin.gif[/img]

Posted on: Sat, 04/12/2003 - 1:04pm
darthcleo's picture
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Joined: 11/08/2000 - 09:00

You're welcome all. Can I get that merlot too?
Last time we visited the ER, (and we got listed at level 4 but they never told us that [img]http://uumor.pair.com/nutalle2/peanutallergy/frown.gif[/img] ...) someone had been waiting for 8 hours with a sick child (stomach cramps, probably the flu) and that father got very very cranky. The nurse had to explain the levels to him but he wouldn't get it. (he was level 4, like us but were ahead of us).
Everyone wants to be at level 1, and it's understandable. I just had a crash lesson, I guess [img]http://uumor.pair.com/nutalle2/peanutallergy/wink.gif[/img]
I think the protocol is fine as it is. Level II is a very serious level where intervention has to be done within a small amount of time. It's like being at red alert for a terrorist attack . Level 1 is when the terrorist attack is actually under way.
Or another way of looking at it. Level 2 is when your contractions are less than 2 minutes apart. Level 1 is when the baby's crowning. (let's use something positive here ;-)

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