12/5/2016

BMJ.RO | The British Medical Journal - Editia in limba romana

(/)

HOME(/)

DESPRENOI(/DESPRENOI)

NUMARULCURENT(HTTP://WWW.BMJ.RO/REVISTA/SEPTEMBRIE2016NR7)
ARTICOLEPECATEGORII(/CATEGORII)

ARHIVA(/ARHIVAREVISTE)

MULTIMEDIA(/MULTIMEDIA)

CONTACT(/CONTACT)

CHESTIONARE(HTTP://CHESTIONARE.TARUSMEDIA.RO/)
INTEGRITATEAINCERCETARE(/ARTICLES/INTEGRITATEACERCETARE)
CERCETARE(/ARTICLES/CERCETARE)

ISTORIE(/ARTICLES/ISTORIE)

CONTROVERSE(/ARTICLES/CONTROVERSE)

STIRI(/ARTICLES/STIRI)
EVENIMENTE(/ARTICLES/EVENIMENTE)
EDITORIAL(/ARTICLES/EDITORIAL)

ACTUALITATI(/ARTICLES/ACTUALITATI)

OBSERVATII(/ARTICLES/OBSERVATII)

ANALIZE,CONTROVERSE,OBSERVATII(/ARTICLES/ANALIZECONTROVERSEOBSERVATII)
SINTEZECLINICE(/ARTICLES/SINTEZECLINICE)

PRACTICAMEDICALA(/ARTICLES/PRACTICAMEDICALA)

OPINIISIRECENZII(/ARTICLES/OPINIISIRECENZII)

MINERVA(/ARTICLES/MINERVA)

PUNCTEDEVEDERE(/ARTICLES/PUNCTEDEVEDERE)
Home(/)Editorial(/articles/editorial)Tratamentuldeurgenaloculuianafilactic

Tratamentuldeurgenaloculuianafilactic
TrimisdeadminlaSm,10/25/200810:00

http://www.bmj.ro/articles/2008/10/25/tratamentul-de-urgen%C5%A3%C3%A3-al-%C5%9Focului-anafilactic

1/11

12/5/2016

BMJ.RO | The British Medical Journal - Editia in limba romana

Share

ResuscitationCouncil(ConsiliuldeResuscitare)din
MareaBritanieareactualizat,decurnd,
recomandrilereferitoarelatratamentuldeurgen
aloculuianafilactic.1
Eleatragateniaasupraimportaneisolicitrii
precoceaintervenieiambulaneisauaechipeide
resuscitareiintroducabordareaABCDEci
aeriene,respiraie,circulaie,nivelalstriide
contieniexpunere(ategumentului).nghidse
subliniazctratamentuliniialdeelecieconstn
administrareaintramuscularpromptaadrenalinei
(epinefrin),mpreuncucelelaltemsuriindicate,
cepotconstan:aezareapacientuluintropoziie
confortabil,asigurareapermeabilitiicilor
aeriene,administrareaintravenoasaunuiflux
crescutdeoxigeniaunuivolumlichidianmai
mare.Semairecomanddirecionareaulterioara
bolnavuluictreconsultalergologicdespecialitate,
nvedereaevaluriiriscurilor,precumiinstituirea
petermenlungamsurilornecesare,pentru
reducereariscurilor.
Momentan,pepianuexistmedicamentenoi
pentrutratamentulacutaloculuianafilacticcele
disponibile,precumadrenalina,glucocorticoizii,
antihistaminiceleantiH1iantiH2,suntutilizatenc
dinperioadapremergtoaretrialurilorcontrolate
randomizateiamediciniibazatepedovezi.Suntn
cursderealizarectevasintezesistematice
privitoarelafolosirearespectivelormedicamenteeleurmresccertificareabazeidedoveziexistente,24laconstituireacreia
aucontribuitexperienacliniciopiniaexperilor,studiileobservaionale,celeepidemiologice,defatalitate,experimentelein
vitro,precumicelerandomizate,controlateplacebo,efectuatepemodeleanimaleipeloturidepersoanecuantecedentede
http://www.bmj.ro/articles/2008/10/25/tratamentul-de-urgen%C5%A3%C3%A3-al-%C5%9Focului-anafilactic

2/11

12/5/2016

BMJ.RO | The British Medical Journal - Editia in limba romana

anafilaxie,darasimptomaticenmomentuldesfurriistudiului.57
Aufostpublicatedoarpuineghidurinaionaledespretratamentuloculuianafilactic,dartoatesubliniazrolulfundamentalal
adrenalineinmanagementulacut.1,8Esteinteresantfaptulcnuexistunconsensnceeaceprivetedozainiial
intramuscular,carencazulpacienilorcuvrstedepeste12aniestede0,5mg,nMareaBritanie,ide0,30,5mg,n
majoritateacelorlalteghiduri.1,8
Prinefectelesalea1adrenergice,adrenalinaprevineiamelioreazedemullaringianicolapsulcirculator,iarprinaciuneasa
2adrenergicinducebronhodilataieireduceeliberareahistamineiiaaltormediatori.Separecexistoscurtperioad
deoportunitate,ntructesteeficientodozrelativsczut,injectatintramusculardeexemplu,0,3mg.Eecul
administrriiprompteaadrenalineicreterisculproduceriireaciiloranafilacticebifaziceiadecesului.Cutoatec,uneori,
adrenalinaafostfactorulincriminatafiindusinfarctulmiocardicitulburrilederitmcardiac,acesteapotsurvenichiardatorit
anafilaxiei,naintedeadministrareasubstaneincauz.6,7Apariiatranzitorieapalpitaiilor,atremoruluiiapalorii,dup
injectareaadrenalinei,reflectefectelefarmacologiceanticipatealemedicamentului.
namplasamentelemedicale,risculapariieiconsecinelornociveestemaisczutncazuladministrriiintramuscularea
adrenalineidectncelalutilizriiciiintravenoase.Aacumsubliniazighidulbritanicreactualizat,abordareaintavenoas
impunemonitorizareacontinuititrareadozeidectreunmedicspecialistpregtitcorespunztor.1Stabilireaeronati
ntrziatadozeideadrenalinafostatribuitfolosiriicurenteadiluiilordeexemplu,1:1000pentruexprimarea
concentraiilormedicamentoase.Deaceea,sepreferutilizareaconcentraiilordemasdepild,miligramepermililitru.9
ncomunitate,dispozitivelepentruautoadministrareaadrenalineisuntexcesivprescrisenuneleri,pecndnmultealtele
fienuexistpepia,fiesuntpreascumpe10i,chiariatuncicndsuntdisponibileiaccesibiledinpunctdevedere
financiar,suntsubutilizatencazdereaciianafilactice.Limiteledispozitivelordeautoadministrareaadrenalineiexistenten
prezentconstaunnumrullimitatdedozepremsurateiallungimiloracelor.6,7
Spredeosebirederecomandrileuniversalereferitoarelaadministrareainjectabilaadrenalineinoculanafilactic,ghidurile
naionalenusuntdeacordnceeacepriveterolulaltormedicamenteutilizatenmodcurent,precumglucocorticoizii,
antihistaminiceleantiH1iantiH2ntradevr,antihistaminiceleantiH2nusuntnicimcarmenionatenghidulbritanic.1,8
Prinurmare,elearputeaconstituiobiectuldestudiualunortrialuriprospective,multicentrice,controlateplacebo,randomizate,
cuostructurriguroas,caresletestezepefiecarenparte,lunduseprecauiilecorespunztoareirespectnduse
msurilestandarddetratamentceincludadministrareaadrenalinei,poziionareaconfortabilapacientului,asigurarea
permeabilitiiciloraeriene,suplimentareaaportuluideoxigeniadministrareaintravenoasdelichide,conformindicaiilor.
Esteevidentfaptulcefectuareaunortrialuriplacebocontrolatecuprivirelafolosireaadrenalineiarfilipsitdeetic1,4,57
ntradevr,unmotivdengrijorarelconstituieisubutilizareaeinoculanafilacticnamplasamentelemedicale.11Cutoate
http://www.bmj.ro/articles/2008/10/25/tratamentul-de-urgen%C5%A3%C3%A3-al-%C5%9Focului-anafilactic

3/11

12/5/2016

BMJ.RO | The British Medical Journal - Editia in limba romana

acestea,arfiposibilefectuareaunortrialurirandomizatecarescomparedoudozediferitedeadrenalindeexemplu,
celedoudozerecomandateuzualpentruadministrareainiialintramuscular,de0,3mgi,respectiv,de0,5mg.
Indiferentdeintervenie,efectuareaunortrialuricontrolaterandomizatearfidificillapersoanelecareseprezintla
departamenteledeurgencuocanafilactic,deoareceparametriiiniialinusuntdisponibili,iarsimptomeleisemneledeoc
anafilacticpotfiamelioratedatoritmsurilordeprimajutorsauproducieiendogenedeadrenalin,angiotensinII,endotelin
ialtesubstane.
Poatecastfeldestudiiarfi,totui,fezabilencadruldepartamentelormedicalebineechipate,ncareapar,uneori,cazuride
anafilaxiedeexemplu,nsituaiapacienilorsupuiunuitestdeprovocarelaalimentesaulanepturideinsecte,substrict
supravegheremedical,cuscopulstabiliriirisculuianafilacticsaunceaapersoanelorsupuseimunoterapieialergenspecifice.
nasemeneadepartamente,ncarepersonalulmedicalestepregtitcorespunztoriareexperiennprevenirea,
recunoatereaimanagementulanafilaxiei,arfiposibilobinereacosimmntuluiinformatiarfidisponibiliparametrii
bazali.nplus,dacseproduce,totui,ocanafilactic,tratamentulcuadrenalin,poziionareaconfortabilapacientului,
managementulciloraeriene,suplimentareacuoxigenihidratareaintravenoasarfipromptinstituite,conformindicaiilor.
Potfimonitorizate,deasemenea,funciacardiac,tensiuneaarterialisaturaianoxigen.mbuntireacapacitaiide
confirmareadiagnosticuluiclinicprintruntestdelaborator,validareaunuiscordeseveritatepentruoculanafilactici
stabilireaaltorparametriiclinicipotajutalarealizareaunorataristudii.12
nconcluzie,ghidulbritanicreactualizatpentrutratamentuldeurgenalreaciiloranafilacticeesteoimportantsursde
informaieiunmodelpentruelaborareaaltorghidurinaionaleiinternaionaledestinatetratamentuluioculuianafilactic.Pe
viitor,trebuieavutnvedereposibilitateaefecturiiunortrialuricontrolaterandomizate.
FEstelleRSimonsprofessor
DepartmentofPediatricsandChildHealth,FacultyofMedicine,UniversityofManitoba,Winnipeg,MB,CanadaR3A1R9
lmcniven@hsc.mb.ca(mailto:lmcniven@hsc.mb.ca)
Conflictedeinterese:FERSestemembraconsiliuluideconsultanmedicalalDeyLP.Nuabeneficiatdefinanaredin
parteacompaniilorfarmaceuticesaualtfeldefinanripentrucercetriasupraoculuianafilacticsauasupraepinefrinei.
Provenienimodalitatederecenzie:ArticolsolicitatdeBMJ,frrecenzareextern.
Emergencytreatmentofanaphylaxis
RevisedUKguidelinesareaconciseevidencebasedresource
BMJ2008336:11412

http://www.bmj.ro/articles/2008/10/25/tratamentul-de-urgen%C5%A3%C3%A3-al-%C5%9Focului-anafilactic

4/11

12/5/2016

BMJ.RO | The British Medical Journal - Editia in limba romana

doi:10.1136/bmj.39547.452153.80
1WorkingGroupoftheResuscitationCouncil(UK).Emergencytreatmentofanaphylacticreactions.Guidelinesforhealthcare
Acestsitefolosetecookieuri.Princontinuareanavigarii,etideacordcumodulde
providers.2008.www.resus.org.uk/pages/reaction.pdf(http://www.resus.org.uk/pages/reaction.pdf).
Deacord.
Dorescmaimulteinformatii...
utilizareaacestorinformaii.

2.SimonsFER,SheikhA.Evidencebasedmanagementofanaphylaxis.Allergy200762:8279.
3.SheikhA,tenBroekVM,BrownSGA,SimonsFER.H1antihistaminesforthetreatmentofanaphylaxiswithandwithout
shock.CochraneDatabaseSystRev2007(1):CD006160.
4.SheikhA,ShehataY,BrownSGA,SimonsFER.Adrenalineforthetreatmentofanaphylaxiswithandwithoutshock.
CochraneDatabaseSystRev2007(1):CD006312.
5.McLeanTookeAPC,BethuneCA,FayAC,SpickettGP.Adrenalineinthetreatmentofanaphylaxis:whatistheevidence?
BMJ2003327:13325.
6.SimonsFER.Firstaidtreatmentofanaphylaxistofood:focusonepinephrine.JAllergyClinImmunol2004113:83744.
7.SimonsFER.Anaphylaxis:evidencebasedlongtermriskreductioninthecommunity.ImmunolAllergyClinNorthAm
200727:23148.
8.AlrasbiM,SheikhA.Comparisonofinternationalguidelinesfortheemergencymedicalmanagementofanaphylaxis.Allergy
200762:83841.
9.WheelerDW,CarterJJ,MurrayLJ,DegnanBA,DunlingCP,SalvadorR,etal.Theeffectofdrugconcentrationexpression
onepinephrinedosingerrors:arandomizedtrial.AnnInternMed2008148:114.
10.SimonsFER.Lackofworldwideavailabilityofepinephrineautoinjectorsforoutpatientsatriskofanaphylaxis.AnnAllergy
AsthmaImmunol200594:5348.
11.GaetaTJ,ClarkS,PelletierAJ,CamargoCA.NationalstudyofUSemergencydepartmentvisitsforacuteallergic
reactions,1993to2004.AnnAllergyAsthmaImmunol200798:3605.
12.SampsonHA,MunozFurlongA,CampbellRL,AdkinsonNFJr,BockSA,BranumA,etal.Secondsymposiumonthe
definitionandmanagementofanaphylaxis:summaryreportsecondNationalInstituteofAllergyandInfectiousDisease/Food
AllergyandAnaphylaxisNetworksymposium.JAllergyClinImmunol2006117:3917.
Ratethisarticle:

Average:5(1vote)

Bibliografie:
Traducere:
Dr.OlguaIliescu
http://www.bmj.ro/articles/2008/10/25/tratamentul-de-urgen%C5%A3%C3%A3-al-%C5%9Focului-anafilactic

5/11

12/5/2016

BMJ.RO | The British Medical Journal - Editia in limba romana

Autor:
Revista:
Octombrie2008/Nr.8(/revista/octombrie2008nr8)

Acestsitefolosetecookieuri.Princontinuareanavigarii,etideacordcumodulde
Deacord.
utilizareaacestorinformaii.
Autentificare(/user/login?destination=node/4663%23commentform)pentruapostacomentarii

Dorescmaimulteinformatii...

SearchArticles...
(mailto:contact@bmj.ro)

(http://www.bmj.com/theBMJ)

(http://shop.tarusmedia.ro/13publicatiimedicale)

(http://www.bmj.ro/articles/2014/06/18/creditedeeducatiemedicalacontinuaemc)

http://www.bmj.ro/articles/2008/10/25/tratamentul-de-urgen%C5%A3%C3%A3-al-%C5%9Focului-anafilactic

6/11

12/5/2016

BMJ.RO | The British Medical Journal - Editia in limba romana

Acestsitefolosetecookieuri.Princontinuareanavigarii,etideacordcumodulde
utilizareaacestorinformaii.

Deacord.

Dorescmaimulteinformatii...

(http://www.bmj.ro/revista/septembrie2016nr7)

(http://medicaacademica.ro)
Jumpbacktonavigation(#page)

Celemaipopularearticole
http://www.bmj.ro/articles/2008/10/25/tratamentul-de-urgen%C5%A3%C3%A3-al-%C5%9Focului-anafilactic

7/11

12/5/2016

BMJ.RO | The British Medical Journal - Editia in limba romana

(/articles/2008/10/28/ceanumetrebuies%C4%83%C5%9Ftie
pacien%C5%A3iidespreterapiacuiodradioactiv)
Acestsitefolosetecookieuri.Princontinuareanavigarii,etideacordcumodulde
utilizareaacestorinformaii.
Ceanumetrebuiestiepacieniidespre

Deacord.

Dorescmaimulteinformatii...

terapiacuiodradioactiv
(/articles/2008/10/28/ceanumetrebuies%C4%83
%C5%9Ftiepacien%C5%A3iidespreterapiacu
iodradioactiv)
Editorial(/articles/editorial)0comentariu(i)
(http://www.bmj.ro/articles/2008/10/28/ceanumetrebuie
s%C4%83%C5%9Ftiepacien%C5%A3iidespreterapiacuiod
radioactiv#comments#comments)

(/articles/2008/10/27/scabiadiagnostic%C5%9Fitratament)

Sc
ab
ia:

diagnosticitratament
(/articles/2008/10/27/scabiadiagnostic%C5%9Fi
tratament)
Sintezeclinice(/articles/sintezeclinice)0comentariu(i)
(http://www.bmj.ro/articles/2008/10/27/scabiadiagnostic
%C5%9Fitratament#comments#comments)

(/articles/2013/12/05/investigareauneitrombocitopenii
descoperiteintamplator)

Investigareauneitrombocitopenii
descoperiteintamplator
(/articles/2013/12/05/investigareaunei
trombocitopeniidescoperiteintamplator)
Practicamedicala(/articles/practicamedicala)0
comentariu(i)
(http://www.bmj.ro/articles/2013/12/05/investigareaunei
trombocitopeniidescoperite
intamplator#comments#comments)

Cumtrebuieinvestigatunpacientcu
http://www.bmj.ro/articles/2008/10/25/tratamentul-de-urgen%C5%A3%C3%A3-al-%C5%9Focului-anafilactic

8/11

12/5/2016

BMJ.RO | The British Medical Journal - Editia in limba romana

(/articles/2010/10/12/cumtrebuieinvestigatunpacientcu
suspiciunedeboalapulmonarainterstitiala)
Acestsitefolosetecookieuri.Princontinuareanavigarii,etideacordcumodulde
utilizareaacestorinformaii.
suspiciunedeboalapulmonara
interstitiala?(/articles/2010/10/12/cumtrebuie

Deacord.

Dorescmaimulteinformatii...

investigatunpacientcususpiciunedeboala
pulmonarainterstitiala)
Sintezeclinice(/articles/sintezeclinice)0comentariu(i)
(http://www.bmj.ro/articles/2010/10/12/cumtrebuieinvestigat
unpacientcususpiciunedeboalapulmonara
interstitiala#comments#comments)

Jumpbacktonavigation(#page)

SearchArticles...

BMJ.ro
2Klikes

LikePage

Bethefirstofyourfriendsto
likethis

Contactatine

Urmaritine

http://www.bmj.ro/articles/2008/10/25/tratamentul-de-urgen%C5%A3%C3%A3-al-%C5%9Focului-anafilactic

9/11

12/5/2016

BMJ.RO | The British Medical Journal - Editia in limba romana

TermenisiconditiideutilizareaBMJ.RO
(http://www.bmj.ro/content/termenisiconditii)

UrmaritinepeFacebook
(https://www.facebook.com/BMJ.Romania)

Acestsitefolosetecookieuri.Princontinuareanavigarii,etideacordcumodulde

utilizareaacestorinformaii.
TarusMediaSRL

Deacord.

Dorescmaimulteinformatii...

Bdul.Metalurgiei,Nr.78,Sector4
Sector4,041836,Bucuresti
Tel/Fax:021/321.01.90
Email:bmjro@tarus.eu(mailto:bmjro@tarus.eu)

LINKURI
TARUSMedia(http://www.tarusmedia.ro/)
MedicaAcademica(http://medicaacademica.ro/)
FarmaceuticaREMEDIA(http://www.remedia.ro/)
FarmaciileREMEDIA(http://farmaciileremedia.ro/)
PensiuneaANASTASIAJurilovca(http://anastasiajurilovca.ro/)
CabanaCASCADARETEZAT(http://www.retezatcascada.ro/)
FIVEplusartgallery(http://fiveplusartgallery.eu/)

Postarirecente

(/articles/2016/08/31/profdrmihaivoiculescumemoriam)

Prof.Dr.MihaiVOICULESCUInmemoriam
(/articles/2016/08/31/profdrmihaivoiculescumemoriam)

Stiri(/articles/stiri)acum3luni6zile

Articolevizualizaterecent
Eficienaadministrriiantibioticelorblactamice,fa
deceleactivepeagenipatogeniatipici,ntratamentul
formeloruoaresaumoderatedepneumonie
comunitardobndit:metanaliz
(/articles/2008/10/24/eficien%C5%A3aadministr%C4%83rii
antibioticelorblactamicefa%C5%A3%C4%83decele
activepeagen%C5%A3i)

Practicamedicala(/articles/practicamedicala)accesat
Folosireadelainceputaazitromicineipoatereduce
severitateawheezingului,conformrezultatelorunui
http://www.bmj.ro/articles/2008/10/25/tratamentul-de-urgen%C5%A3%C3%A3-al-%C5%9Focului-anafilactic

[timestamp]
10/11

12/5/2016

BMJ.RO | The British Medical Journal - Editia in limba romana

Simptomeleceafecteazstareadesntateafemeilor
npreajmavrsteide50deaniicorelaialorcu
perioadadetranziiespremenopauz:studiubritanic
(/articles/2016/04/19/folosireadelainceputazitromicinei
prospectiv,decohort(/articles/2012/06/16/simptomele
Acestsitefolosetecookieuri.Princontinuareanavigarii,etideacordcumodulde
poatereduceseveritateawheezingului)

ceafecteaz%C4%83stareades%C4%83n%C4%83tate
Deacord.
Dorescmaimulteinformatii...
utilizareaacestorinformaii.
studiu(/articles/2016/04/19/folosireadelainceput
azitromicineipoatereduceseveritateawheezingului)

Cercetare(/articles/cercetare)acum7luni2sptmni

PERSPECTIVA
ACUTA
(/articles/2016/04/19/perspectivaacuta)
(/articles/2016/04/19/perspectivaacuta)

Opiniisirecenzii(/articles/opiniisirecenzii)acum7luni
2sptmni

femeilor%C3%AEnpreajmav%C8%83rsteide50de)

Cercetare(/articles/cercetare)accesat[timestamp]

Modificrirecentenmanagementulpneumoniei
comunitare,laaduli
(/articles/2008/11/26/modific%C3%A3rirecente%C3%AEn
managementulpneumonieicomunitarelaadul%C5%A3i)

Sintezeclinice(/articles/sintezeclinice)accesat
[timestamp]

Sistemmultimodaldestinatreduceriierorilordin
nregistrareaiadministrareamedicamentelorn
anestezie:evaluareclinic,prospectiv,randomizat
(/articles/2016/04/19/transplantuldemateriifecale)

Transplantuldemateriifecale

(/articles/2012/02/15/sistemmultimodaldestinatreducerii
erorilordin%C3%AEnregistrarea%C5%9Fiadministrarea)

(/articles/2016/04/19/transplantuldemateriifecale)

Cercetare(/articles/cercetare)accesat[timestamp]
Editorial(/articles/editorial)acum7luni2sptmni

TheBMJCopyright2015
Esteinterzisareproducerea,distribuireasaupublicareasuboriceformaacontinutuluimaterialelorprezentatepeacestsite,decatreorice
persoana,faraacordulscrisprealabilalTheBMJ.

http://www.bmj.ro/articles/2008/10/25/tratamentul-de-urgen%C5%A3%C3%A3-al-%C5%9Focului-anafilactic

11/11