Discharge And Home Healthcare Guidelines

PREVENTION OF ASPIRATION. Teach the family or caregivers how to protect the patient's airway and dislodge food if the patient aspirates. Teach the patient or family how to suction the patient.

TREATMENT. Provide information regarding home healthcare products that are available and explain how to get them. Explain to the patient and family treatment options such as mechanical ventilation and tracheostomy.

EMOTIONAL. Explore coping strategies. Support groups for ALS patients are available in many cities. Refer the patient or family to Respite Care or the ALS Association.

Anaphylaxis DRG Categ°ry: 447

Mean LOS: 2.3 days Description: MEDICAL: Allergic Reactions, Age > 17

^Anaphylactic shock, or anaphylaxis, is an immediate, life-threatening allergic reaction that is caused by a systemic antigen-antibody immune response to a foreign substance (antigen) introduced into the body. The term was first coined in 1902 when a second dose of a vaccination caused the death of an animal; the animal's death was described as the opposite of prophylaxis, and was therefore called "anaphylaxis," which means "without protection." In the United States, experts estimate that from 20,000 to 50,000 people have anaphylactic shock each year; fatalities are infrequent but as many as 1000 people may die in the United States each year.

Anaphylaxis is caused by a type I, immunoglobulin E-mediated hypersensitivity reaction. The antigen combines with immunoglobulin E (IgE) on the surface of the mast cells, and precipitates a release of histamine and other chemical mediators such as serotonin and slow-reacting substance of anaphylaxis (SRS-A). The resulting increased capillary permeability, smooth muscle contraction, and vasodilation account for the cardiovascular collapse. More than one organ system must be involved to be considered anaphylaxis, and those organs are most commonly the heart, lungs, skin, and gastrointestinal systems.

Bronchoconstriction, bronchospasm, and relative hypovolemia result in impaired airway, breathing, and circulation; death may follow if anaphylaxis is not promptly reversed. Although a delayed reaction may occur 24 hours after the exposure to an antigen, most reactions occur within minutes after exposure, and a recurrence of symptoms may occur after 4 to 8 hours. The most common causes of death from anaphylaxis are airway obstruction and hypotension.

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