MMW Fortschritte der Medizin
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Cases of life-threatening and fatal anaphylaxis represent the most extreme forms of acute allergic reactions. They are estimated to have an incidence of 1-3 per 10,000 persons, with an associated death rate of 0.5-2%. Medicinal drugs, insect stings and foods are the most common triggering agents. ⋯ Fatal anaphylaxis due to foods usually leads first to dyspnea and then to respiratory failure. Allergic bronchial asthma represents a major risk factor. Knowledge of the allergens capable of triggering life-threatening and fatal anaphylaxis makes it easier for the physician to assess the risk potential when confronted by an emergency situation.
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Patients with thoracic pain, acute dyspnea and palpitations represent an acute emergency for the general physician. In every case, initial information is provided by an ECG obtained immediately. Ifa suspected acute coronary syndrome is confirmed, continuous ECG rhythm monitoring must be performed. ⋯ In the event of pulmonary edema, too, initial measures must include oxygen administration, appropriate positioning, administration of a rapid-acting loop diuretic and, where indicated, nitroglycerin. Should tachycardic arrhythmia occur, the width of the ventricular complex must be measured in the ECG before deciding on further treatment. In the out-of-hospital setting, no more than one antiarrhythmic should be given.
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Management of acute emergencies in children has a number of specific aspects, with which the first person providing medical care needs to be familiar. For example, intubation requires knowledge of the particular anatomy of infants and young children. ⋯ Among the causes of cardiac arrest, sudden infant death predominates in babies, while in young and pre-school children, trauma and near-drowning accidents represent the most common events requiring reanimation measures. Of decisive importance for clarifying the cause of death is an accurate documentation of the course of reanimation and the situation initially presenting to the care provider.