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WMS Clinical Practice Guidelines on Anaphylaxis

16 March, 2022
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Anafylaxi, också kallat allergisk chock, är en livshotande allergisk reaktion som uppstår av att kroppen överreagerar på ett ämne man fått i sig.  Wilderness Medical Societys (WMS) har nu publicerat uppdaterade riktlinjer för hur detta tillstånd bäst kan hanteras ute i fält. Riktlinjerna baseras på uppgifter från National Outdoor Leadership School (NOLS) och Outward Bound (OB), och således en amerikansk kontext.

The authors describe the epidemiology, pathophysiology, and the different treatments for anaphylaxis. In summary, the incidence of anaphylaxis is increasing and occurs in 0.01 to 0.03% of students in outdoor educational courses. Worth noting is that a fifth of all cases were first-time reactions in individuals without a known history of allergy. The most common cause of anaphylaxis were food-based allergens or stings and bites.

The authors confirm the previous recommendation that nonmedical professionals, e.g., teachers and guides, should be trained to administer epinephrine in a correct and appropriate way. The legal framework for this varies, it is allowed in some states and prohibited in some. Intramuscular injection of epinephrine is the primary field treatment for anaphylaxis, and the treatment is time-sensitive. The data suggest that in 25 % - 35 % of anaphylaxis cases a second dose is required. Adverse outcomes from field epinephrine include cardiac incidents and stroke, mostly in the elderly, individuals in pre-existing heart conditions, or if wrongly administered. Other medications, e.g., antihistamine, corticosteroids, and inhalations, should not delay the primary treatment. Evacuation is generally recommended, but other considerations may influence the decision. 

Read the guidelines here here

Learn more about anaphylaxis and how to manage it on the course Wilderness Life Support eller i boken Vildmarksmedicin- första hjälpen och sjukvård på tur och expedition.

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