Dossier Thématique - Octobre 2017: Anaphylaxie

  • RFE Anaphylaxie 2016
  • Mode d'emploi des stylos auto-injectables d'adrénaline
  • Diaporama ppt take home message
  • Bibliographie BUS
  • 1) Introduction

    2) Exposé

    3) Diaporama - pptx

    4) Bibliographie BUS

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    med_date_maj => '2017-12-08 20:48:29'
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    med_description_longue => '<p>Introduction&nbsp;: L'adr&eacute;naline est le traitement de premi&egrave;re intention de l'anaphylaxie s&eacute;v&egrave;re de l'enfant selon les recommandations 2006 de la World Allergy Organization.<br /> <br /> Objectif - Evaluer la pr&eacute;valence de son utilisation dans l'anaphylaxie s&eacute;v&egrave;re de l'enfant au niveau des h&ocirc;pitaux d'une m&ecirc;me r&eacute;gion.<br /> <br /> Patients et M&eacute;thodes&nbsp;: Sur la p&eacute;riode 2012-2013, les dossiers d'enfants &acirc;g&eacute;s de moins de 15 ans dont le code diagnostic &eacute;tait cod&eacute; J46, J384, J393, L500, L509, T780, T782, T784 ont &eacute;t&eacute; r&eacute;trospectivement s&eacute;lectionn&eacute;s, et les patients ayant un crit&egrave;re clinique de gravit&eacute; justifiant l'administration d'adr&eacute;naline ont &eacute;t&eacute; inclus.<br /> <br /> R&eacute;sultats&nbsp;: Sur la p&eacute;riode, 116 patients ont &eacute;t&eacute; inclus (58 issus du CHU, 58 des CHR) et auraient d&ucirc; b&eacute;n&eacute;ficier d'une injection d'adr&eacute;naline. Elle a &eacute;t&eacute; inject&eacute;e chez 49 patients (42,2%), 42 patients en CHU et 7 autres en CHR. La posologie et la voie d'administration &eacute;taient adapt&eacute;es dans 100% des cas. La moyenne d'&acirc;ge des patients &eacute;tait de 5,8&plusmn; 4,3 ans, il existait un gradient de gravit&eacute; clinique inversement li&eacute; &agrave; l'&acirc;ge&nbsp;: le groupe d'&acirc;ge inf&eacute;rieur &agrave; 2 ans comportait 42% de patients graves (3,2 [1,3-7,9[, p=0,014). Le transport &eacute;tait m&eacute;dicalis&eacute; dans 8% des cas, 45% d'entre eux &eacute;taient exempts d'ant&eacute;c&eacute;dents allergiques. Les manifestations cliniques &eacute;taient essentiellement cutan&eacute;omuqueuses (62%) et respiratoires (28%). Une expansion vol&eacute;mique par cristallo&iuml;des &eacute;tait prescrite chez 20 patients (91% des patients hypotendus). Il n'existait pas de diff&eacute;rence en terme de gravit&eacute; entre les patients ayant re&ccedil;u de l'adr&eacute;naline et les autres. Parmi les patients pr&eacute;sentant des crit&egrave;res de gravit&eacute; clinico-biologiques (n=27), 40% ont b&eacute;n&eacute;fici&eacute; d'une injection d'adr&eacute;naline. Un antihistaminique H1 ou un cortico&iuml;de seul &eacute;tait prescrit dans 15% des cas, la posologie de la m&eacute;quitazine, antiH1 le plus prescrit, &eacute;tait sous dos&eacute;e chez 42% des enfants. A l'issue de la surveillance aux urgences, une hospitalisation &eacute;tait n&eacute;cessaire dans 59,5% des cas.<br /> <br /> Conclusion&nbsp;: Dans des situations o&ugrave; elle est recommand&eacute;e, l'utilisation de l'adr&eacute;naline reste insuffisante. Des r&eacute;ticences &agrave; son injection persistent notamment en lien avec l'hypoth&eacute;tique risque cardiovasculaire secondaire, risque th&eacute;orique dans la population p&eacute;diatrique exempte de pathologies coronariennes.</p>'
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    med_description_longue => '<p><strong>Introduction</strong>&nbsp;: Chez l&rsquo;enfant, les m&eacute;dicaments sont insuffisamment &eacute;tudi&eacute;s. La prescription m&eacute;dicamenteuse est particuli&egrave;rement difficile et souvent hors autorisation de mise sur le march&eacute;. De plus, du fait d&rsquo;un m&eacute;tabolisme diff&eacute;rent de celui de l&rsquo;adulte, les effets ind&eacute;sirables sont souvent diff&eacute;rents de chez l&rsquo;adulte. Enfin, le service d&rsquo;aide m&eacute;dicale urgente (SAMU) &eacute;tant une interface particuli&egrave;re entre la population g&eacute;n&eacute;rale et les &eacute;tablissements de sant&eacute;, il nous a sembl&eacute; important de s&rsquo;int&eacute;resser &agrave; la pharmacovigilance au sein d&rsquo;un SAMU en d&eacute;terminant l'incidence des appels au centre de r&eacute;ception et de r&eacute;gulation des appels (CRRA) d&rsquo;un SAMU pour un effet ind&eacute;sirable m&eacute;dicamenteux (EIM) ayant concern&eacute; un patient mineur.</p> <p><strong>Patients et M&eacute;thode&nbsp;: </strong>Etude r&eacute;trospective observationnelle, monocentrique entre le 1<sup>e</sup> janvier 2011 et le 31 d&eacute;cembre 2012. Nous avons inclus tous les dossiers de r&eacute;gulation m&eacute;dicale dont le diagnostic m&eacute;dical &eacute;tait cod&eacute; en accident iatrog&egrave;ne,&nbsp;vomissements, malaise, vertiges, h&eacute;morragies, allergie ou hypoglyc&eacute;mie (d&eacute;finis lors d&rsquo;une pr&eacute;-&eacute;tude). Le crit&egrave;re de jugement principal &eacute;tait la pr&eacute;sence d&rsquo;un EIM imputable &agrave; un m&eacute;dicament et ayant entra&icirc;n&eacute; un appel au CRRA pour un enfant jusqu&rsquo;&agrave; 18 ans exclus. Nous avons r&eacute;alis&eacute; une analyse descriptive des donn&eacute;es. Les statistiques &eacute;taient r&eacute;alis&eacute;es gr&acirc;ce au logiciel Excel&deg; (Microsoft Corporation, 2007, Richmond, USA).</p> <p><strong>R&eacute;sultats&nbsp;</strong>: Sur une p&eacute;riode de 2 ans,250 EIM &eacute;taient inclus. L&rsquo;incidence des appels au CRRA pour EIM &eacute;tait de 0,16%. Le sexe ratio &eacute;tait de 0,87 (117 hommes pour 133 femmes). L&rsquo;EIM le plus fr&eacute;quent &eacute;tait l&rsquo;allergie (n=133; 53,2%) puis les vomissements (n=57; 22,8%). Au total, 336 m&eacute;dicaments &eacute;taient imput&eacute;s puisque un patient pouvait avoir pris plusieurs m&eacute;dicaments en m&ecirc;me temps. Les m&eacute;dicaments les plus fr&eacute;quemment en cause &eacute;taient les antibiotiques (n=145; 43,2%), les antalgiques/antipyr&eacute;tiques (n=41; 12,5%), les anti inflammatoires (n=27; 8,0%) et les vaccins (n=24; 7,1%). Les EIM graves (uniquement des hospitalisations) repr&eacute;sentaient 1,6 % des EIM (n=4).</p> <p><strong>Conclusion</strong>&nbsp;: Cette &eacute;tude est la premi&egrave;re &agrave; d&eacute;finir cette incidence chez le patient mineur. Elle permet d&rsquo;insister sur la n&eacute;cessaire sensibilisation des m&eacute;decins &agrave; la pharmacovigilance afin d&rsquo;am&eacute;liorer la prise en charge de cette population sensible. Elle contribue &agrave; avoir une meilleure visibilit&eacute; sur les EIM en soins primaires.</p>'
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    med_auteurs => 'Mouna Gammoudi (1), Hanen Ghazali (1), Rym Kaddour (1), Mohamed Mguidich (2), Anware Yahmadi (3), Ahlem Azouzi (1), Ali Ben Yahya (1), Sami Souissi (4)'
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    med_description_longue => '<p><span style="font-family: Calibri;">Introduction: L&rsquo;anaphylaxie est une r&eacute;action syst&eacute;mique grave qui s&rsquo;inscrit dans le cadre g&eacute;n&eacute;ral des r&eacute;actions d&rsquo;hypersensibilit&eacute; potentiellement fatale n&eacute;cessitant une prise en charge imm&eacute;diate (Simpson et al 2006). <br /> Objectif : Etudier les caract&eacute;ristiques cliniques et les facteurs de risque associ&eacute;s au choc chez les patients se pr&eacute;sentant aux urgences pour anaphylaxie.<br /> M&eacute;thodologie: Etude prospective men&eacute;e sur 2ans. Inclusion des patients dont le diagnostic d'anaphylaxie a &eacute;t&eacute; retenu selon les crit&egrave;res d&eacute;finis par Simpson. Division des patients en 2 groupes: groupe1(G1): patients pr&eacute;sentant un choc anaphylactique d&eacute;fini par une pression art&eacute;rielle systolique &lt;90 mmHg n&eacute;cessitant le recours &agrave; l&rsquo;adr&eacute;naline intraveineuse et groupe2 (G2): patients sans choc. Une analyse multivari&eacute;e a &eacute;t&eacute; r&eacute;alis&eacute;e pour identifier les facteurs de risques associ&eacute;s au choc.<br /> R&eacute;sultats: Inclusion de 239 &nbsp;patients. Age moyen = 39 &plusmn; 15 ans. Sex ratio = 0,83. Cent vingt-quatre patients ont &eacute;t&eacute; inclus dans le G1 contre 115 dans le G2. Les caract&eacute;ristiques d&eacute;mographiques &eacute;taient comparables. L&rsquo;analyse multivari&eacute;e a identifi&eacute; 5 facteurs de risque associ&eacute;s au choc (tableau). <br /> Conclusion: Les ant&eacute;c&eacute;dents d&rsquo;anaphylaxie, le d&eacute;lai d&rsquo;apparition des sympt&ocirc;mes jusqu&rsquo;&agrave; la consultation (DSC), la prise d&rsquo;antibiotiques, la voie parent&eacute;rale et les signes neurologiques sont des facteurs de risque de choc. Leur reconnaissance pr&eacute;coce est primordiale pour une meilleure prise en charge dans les services d&rsquo;urgence.</span></p> <p><br />\n<br />\n</p> <div> <table border="1" cellspacing="0" cellpadding="0"> <tbody> <tr> <td colspan="2" width="154" valign="top"> <p><strong><span style="font-family: Calibri;">Facteurs </span></strong></p> </td> <td width="154" valign="top"> <p><strong><span style="font-family: Calibri;">OR <sub>ajust&eacute;</sub></span></strong></p> </td> <td colspan="2" width="154" valign="top"> <p><strong><span style="font-family: Calibri;">IC95%</span></strong></p> </td> <td colspan="3" width="154" valign="top"> <p><strong><span style="font-family: Calibri;">P</span></strong></p> </td> </tr> <tr> <td colspan="2" width="154" valign="top"> <p><strong><span style="font-family: Calibri;">Ant&eacute;c&eacute;dents d&rsquo;anaphylaxie</span></strong></p> </td> <td width="154" valign="top"> <p><span style="font-family: Calibri;">1,35</span></p> </td> <td colspan="2" width="154" valign="top"> <p><span style="font-family: Calibri;">[1,03&nbsp;; 1,77]</span></p> </td> <td colspan="3" width="154" valign="top"> <p><span style="font-family: Calibri;">0,02</span></p> </td> </tr> <tr> <td width="131" valign="top"> <p><strong><span style="font-family: Calibri;">DSC=68 min&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span></strong></p> </td> <td colspan="3" width="183" valign="top"> <p><span style="font-family: Calibri;">2,5</span></p> </td> <td colspan="2" width="151" valign="top"> <p><span style="font-family: Calibri;">&nbsp;&nbsp; [1,4&nbsp;; 4,7]</span></p> </td> <td width="126" valign="top"> <p><span style="font-family: Calibri;">0,002</span></p> </td> <td width="23"> <p><span style="font-family: Calibri; font-size: medium;">&nbsp;</span></p> </td> </tr> <tr> <td colspan="2" width="154" valign="top"> <p><strong><span style="font-family: Calibri;">Prise ATB</span></strong></p> </td> <td width="154" valign="top"> <p><span style="font-family: Calibri;">1,38</span></p> </td> <td colspan="2" width="154" valign="top"> <p><span style="font-family: Calibri;">[1,04&nbsp;; 1,82]</span></p> </td> <td colspan="3" width="154" valign="top"> <p><span style="font-family: Calibri;">0,02</span></p> </td> </tr> <tr> <td colspan="2" width="154" valign="top"> <p><strong><span style="font-family: Calibri;">Voie parent&eacute;rale </span></strong></p> </td> <td width="154" valign="top"> <p><span style="font-family: Calibri;">2,27</span></p> </td> <td colspan="2" width="154" valign="top"> <p><span style="font-family: Calibri;">[1,03&nbsp;; 4,97]</span></p> </td> <td colspan="3" width="154" valign="top"> <p><span style="font-family: Calibri;">0.04</span></p> </td> </tr> <tr> <td colspan="2" width="154" valign="top"> <p><strong><span style="font-family: Calibri;">Signes neurologiques</span></strong></p> </td> <td width="154" valign="top"> <p><span style="font-family: Calibri;">2,23</span></p> </td> <td colspan="2" width="154" valign="top"> <p><span style="font-family: Calibri;">[1,5&nbsp;; 4,77]</span></p> </td> <td colspan="3" width="154" valign="top"> <p><span style="font-family: Calibri;">0.02</span></p> </td> </tr> </tbody> </table> </div>'
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