GAMBAR PEPEK ANAK SD DI MASUKIN JARI
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Based on the findings of two expert panels attended by international experts in angioedema and emergency medicine, this review aims to provide practical guidance on the diagnosis, differentiation, and management of histamine- and bradykinin-mediated angioedema in the ED.
Angioedema is a relatively common presentation in the ED and is potentially fatal. Angioedema management in the ED starts with assessing and securing the airway while initiating specific treatment. To ensure appropriate treatment and management, determination of whether the angioedema is mediated by histamine or bradykinin is essential. With the current lack of a reliable point-of-care test to distinguish the two pathophysiologies, ED physicians should familiarize themselves with available indicators to help guide treatment decisions. Histamine-mediated angioedema should be treated with H1 and H2 antagonists and oral corticosteroids along with epinephrine, as appropriate. Patients with HAE should receive a medication indicated for treating HAE such as a C1-INH inhibitor, ecallantide, or icatibant. Other causes of bradykinin-mediated angioedema may be treated with FFP.
Hospitals should ensure that adequate procedures and treatments are in place for the management of angioedema. Because bradykinin-mediated angioedema is uncommon, there generally are not protocols in place in the ED and there is a lack of immediate access to appropriate drugs for bradykinin-mediated angioedema. For example, a recent survey of British EDs demonstrated that medications required to treat bradykinin-mediated angioedema were available in the majority of hospitals with specialist immunology services, but were not readily accessible in the ED (e.g., located in the main pharmacy). Additionally, only half the hospitals surveyed had established guidelines for the use of these medications [18].
With degrees in chemical engineering and computer science from Texas A&M University and the University of Houston, Kevin J. Smith began his career at the NASA Johnson Space Center in Houston, supporting the Mission Operations Directorate, and the next twelve years with Manugistics Inc. during the rapid global growth of supply chain management. d2c66b5586