This post was inspired by a conversation with some great people who work for an amazing allergy-related social profit organization Canada. At one point, we discussed the misconceptions and misinformation that even some medical professionals have about anaphylaxis. I’ve certainly been told some odd and incorrect things by people with an M.D. after their names:
1. If you administer your auto-injector, you don’t need to go to the ER. FALSE! It’s not magic. It just buys you time. Many people need additional medications, including more epinephrine. You are literally risking your life if you don’t call an ambulance and head to the hospital.
2. Vomit the food back up and you’ll be fine. VERY FALSE! If your throat is closing up, you risk choking or aspirating on your own vomit, making the situation even worse.
3. The third issue was that a paediatric doctor I know didn’t know how to use an injector in practice and so injected it and let go immediately. While any amount of epinephrine is better than none, hold down that auto-injector for up to 10 seconds. The pressure also helps prevent silly amounts of bleeding.
So, that discussion led to my quick grievance about the lack of an anaphylaxis protocol in ERs. I have mentioned this before and firmly believe that anyone at risk of anaphylaxis should come up with an ER plan in conjunction with their immunologist or allergist. That plan should be communicated to friends and family in case the person is not able to communicate. Put it on paper and keep it in your allergy kit.
The reason behind this is because ER doctors have done everything from give me salbutomol and nothing else (my asthma does not act up during an anaphylactic attack) to giving me a diphenhydramine drip and then discharging me after two hours even though I was still symptomatic. The recommended minimum is four hours and there was no mention of taking diphenhydramine or watching for secondary reactions for 24-72 hours. One doctor rudely asked me what I wanted him to do while my throat was closing up and no medication had been administered by ER staff. I show no external signs of anaphylaxis; so, this may explain some of the oddities I’ve experienced, but there’s definitely no good excuse.
Despite all of that, I do not blame ER doctors. They’re unfathomably busy and have to deal with such a myriad of conditions and patients. Mistakes happen, but not because doctors are reckless or don’t care. They happen because they may not have enough specific training (consider the likelihood of knowing every disease and its treatment in the world. Gregory House M.D. is fictionally crazy after all.) or because areas like ERs and ORs involve a lot of people, responsibilities, stress and various, ever-changing situations. If a doctor has a patient crashing in one room, the girl whose face isn’t swollen and looks just fine will not seem like a priority, even if she should be triaged as though she is.
Specific steps need to be taken upon admittance and post-care. Doctors also need to realize that anaphylaxis does not look the same in everyone. Even the same patient can react differently at different times. Just as there are now checklists for ORs to ensure that protocols exist and are followed (developed by WHO), I would like to see protocols developed for the ER. This takes a lot of the guesswork away from already busy individuals who should be the poster adults for multi-tasking. Where there is uncertainty, there are errors. Too many people died from asthma attacks in Ontario before proper triage and treatment protocols were developed. So, let’s take away the uncertainty.
I will not delve into my opinions of what that protocol should look like, because I am not a medical professional. However, should this post be read by some hospital administrator somewhere, please make a plan. If I know what it should like, your staff can draft it pretty quickly. If you have anaphylaxis or care for someone who has it, make a plan with your immunologist. I’d like to say you can trust an ER doctor with this, but it’s just not a certainty.