Author: admin_nomad

Anaphylaxis: Recognition and Management

Anaphylaxis is a life-threatening emergency and is becoming more common year on year (Pawankar et al, 2013).

 

It is an acute hypersensitivity reaction affecting the skin, respiratory tract, gastrointestinal tract, cardio-vascular system and central nervous system (Kane and Cone, 2015) (Ben-Shoshan and Clarke, 2010).

 

Anaphylaxis pathophysiology resembles that of a normal immune response, except it is systemic, over exaggerated and usually in response to an allergen which would normally be regarded as harmless (Allergy UK, 2015). These allergens can take many forms, and frequently include food, pollen, medications and venoms (Simons and Estelle, 2010).

 

 

RECOGNITION

The most pressing issue when dealing with anaphylaxis is diagnosis, as delay in recognising the condition is regularly associated with poor patient outcomes (Rudders et al, 2011).

 

  • Two of the ‘classic’ signs are swelling and hives which may present visibly over the patients face and body (Jacobsen and Gratton, 2011). This can be seen as an early warning, and helps distinguish from other similar conditions such as a severe asthma attack.

 

  • The respiratory system will be affected if the lumen of the airways closes up due to inflammation and bronchospasm. In the upper airways this results in stridor, while bronchospasm (wheezing) is pathophysiology associated with the lower airways (Bethel, 2013). Increased mucous production also reduces the permeability of the respiratory membrane to gaseous exchange.

 

  • A marked reduction of blood pressure caused by the systemic vasodilatation of the blood vessels in combination with the reduced blood volume is another sign (Philpis et al. 2001). The resulting inability of the patient to maintain adequate perfusion pressures is associated with the onset of hypovolemic shock as the volume of fluid within the cardiovascular system falls (Waugh and Grant, 2014).

 

  • Due to the high density of mast cells within the digestive system, there is often a disturbance to the gastrointestinal tract. This may cause diarrhoea and vomiting to be an associated symptom following increased smooth muscle contraction (Jevon et al. 2004).

 

  • A patient’s history of exposure is vitally important to consider when making a diagnosis and should be considered in combination with the existence of risk factors and clinical symptoms (Bethel, 2013).

 

 

MANAGEMENT

The initial management of anaphylactic patients involves the removal of the trigger, if possible followed by intra-muscular adrenaline, high flow oxygen, chlorphenamine (or other anti-histamine), intra-venous access with possible fluid challenge, hydrocortisone, and salbutamol.

 

Treatment priority is intra-muscular Adrenaline and ensuring adequate patient oxygenation (National Association of EMS Physicians, 2011) (Arnold and Williams, 2011). Adrenaline counteracts the effects of the Histamine release, causing vasoconstriction. This will in turn raise blood pressure and reduce swelling (NHS Choices, 2015). Adrenaline will also cause bronco-dilation due to its effect as a sympathetomimemic.

 

Anaphylaxis can have a devastating effect on the body, and is a time-critical emergency in any environment. If not treated quickly and aggressively it can lead to anaphylactic shock and death. The first line treatment of patients is adrenaline to prevent further deterioration and a fluid challenge for those who are no longer perfusing. Interventions should be based both on recommendations from clinical guidelines as well as evidence-based research, and should always be carried out in accordance with safe and best practice. The importance of education and preparation is paramount for people predisposed to anaphylaxis, as avoiding allergens and early recognition of symptoms may well save their lives.

Female Solo Travellers: Empowerment and Self-Transformation through Negotiating Risk

The emergence of the solo female traveller market globally is a positive step forward in  gender equality, yet solo female travellers can face unique risks.

These risks can be mitigated through appropriate research, planning and preparation prior to departure. Learning about your personal security and actively putting this into practice through subtle techniques when on the road will also help to reduce risks faced.

Yang et al. (2018)| reveal that women can empower themselves through negotiating risk on their travels.

Be prepared. Be a Nomad.

 

  1. Ahokas, S., 2017. Safety of female travellers.
  2. Yang, E.C.L., Khoo-Lattimore, C. and Arcodia, C., 2018. Power and empowerment: How Asian solo female travellers perceive and negotiate risks. Tourism Management, 68, pp.32-45.

High Altitude Illness: Acute Mountain Sickness (AMS) & Lake Louise Score

High Altitude (HA) illness describes a range of conditions; Acute Mountain Sickness (AMS), High Altitude Pulmonary Oedema (HAPE) and High Altitude Cerebral Oedema (HACE).

Acute Mountain Sickness (AMS) is the most common, affecting up to 60% of individuals who ascend over 600 meters(m)/day above 4000m (Maggiorini, 2006).

AMS is characterised by a non-specific set of symptoms experienced at HA including headache, sleep disturbance, nausea and vomiting, dyspnoea, tachycardia and malaise (Borowska et al., 2014; Carod-Artal, 2014).

No objective physiological variable has been identified to diagnose AMS, and it is thus scored via self-assessment questionnaire’s, notably the Lake Louise Score (LLS) (Roach et al., 1993; Shah et al., 2105).

The presence of a headache with a LLS over 3 indicates AMS in individuals who have rapidly ascended above 2500m.

Sharpen the Axe.

Hypothermia Assessment for Rescuers

Assessing the level of hypothermia in cold stressed patients is incredibly important for rescuers.

Two key issues make this relevant;

Firstly, severely hypothermic patients are at a high risk of developing a cardiac arrest (ventricular fibrillation) if not handled carefully, a condition known as ‘circum rescue collapse’ (Zafren et al, 2014).

Secondly, the lack of thermo genetic effort in moderate and severe categories of hypothermia mean that passive re-warming alone is inadequate, and more active re-warming techniques will be required (Epstein and Anna, 2006).

At Nomad we find the “Swiss Staging” model for hypothermia particularly useful as it uses clinical symptoms to estimate the patient’s core temperature without the use of a thermometer. This is useful for rescuers who are unable to obtain an accurate thermometer reading due to situational demands or the fallibility of equipment.

Pasquier, M., Carron, P.N., Rodrigues, A., Dami, F., Frochaux, V., Sartori, C., Deslarzes, T. and Rousson, V., 2019. An evaluation of the Swiss staging model for hypothermia using hospital cases and case reports from the literature. Scandinavian journal of trauma, resuscitation and emergency medicine, 27(1), p.60.

Cold Water Immersion

‘Acute Anxiety Predicts Components of the Cold Shock Response on Cold Water Immersion: Toward an Integrated Psychophysiological Model of Acute Cold Water Survival’ (2017) Barwood et al.

Great paper.

Drowning is one of the leading causes of accidental death globally.

Sudden cooling of the skin during Cold Water Immersion (CWI) can initiate the Cold Shock Response (CSR); tachycardia, peripheral vasoconstriction, hypertension, inspiratory gasping and hyperventilation among others. ⠀⠀⠀⠀

We can train to control the effects of CWI through habitual short immersions, reducing the response to a stimulus of similar magnitude. ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀
We can also use the power of the mind to combat the exacerbating impact that acute anxiety can have on even well trained individuals. ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀
Train the body, train the mind. ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ ⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀⠀ ⠀⠀⠀⠀⠀⠀

Sharpen the axe | Become a NOMAD

 

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