Welcome to REBELCast Episode 1, where Matt, Swami, and I are going to tackle a couple of scenarios to help your clinical practice. Today, we are going to specifically tackle two different topics:
- Topic #1: Clinically Important Biphasic Anaphylaxis
- Topic #2: Total Lymphocyte Count (TLC) as a Surrogate Marker for CD4 Counts
REBELCast Episode 1 Podcast
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What are the clinical questions that will be covered in REBELCast Episode 1?
- Question #1: How long do I really need to monitor a patient for who has presented with anaphylaxis and has complete resolution of symptoms afar administration of medications?
- Question #2: Can we use Total Lymphocyte Count (TLC) as a surrogate marker for CDR counts in HIV/AIDs patients?
What are the specific articles we will be covering?
- Grunau BE et al. Incidence of Clinically Important Biphasic Reactions in Emergency Department Patients with Allergic Reactions or Anaphylaxis. Ann of EM 2014; 63(6): 736 – 44. (24239340)
- Rohacek M et al. Biphasic Anaphylactic Reactions: Occurrence and Mortality. Eur J All Clin Imm 2014; 69(6): 791 – 7. (24725226)
- Obirikorang C et al. Total Lymphocyte Count as a surrogate Marker for CD4 Count in Resource-Limited Settings. BMC Infectious Diseases Journal 2012; 12(128): 1 – 5. ( 22676809)
What are the clinical bottom lines for the above clinical questions:
- Bottom Line #1: Prolonged observation is likely unnecessary in patients who’s symptoms resolve with therapy in the ED. Clinically important biphasic reactions are rare (0.18% – 2.7%), and can occur anywhere from 10 minutes up to 6 days after presentation.
- Bottom Line #2: Total Lymphocyte Count (TLC) can be used as a rough surrogate marker of CD4 counts in patients when the gold standard CD4 count is not available in patients who are not on antiretroviral therapy, but use caution in using this marker as the sole absolute cut-off value in making clinical decisions.
REBELCast Episode 1 Show Notes
Also Checkout some other resources on Anaphylaxis:
- Ken Milne over at the Skeptics Guide to Emergency Medicine: SGEM#57: Should I Stay or Should I Go (Biphasic Anaphylactic Response)
- Kane Guthrie over at Life in The Fast Lane: Pearls and Pitfalls in Anaphylaxis
- Bryan Hayes over at Academic Life in EM: Epinephrine Dosing for Anaphylaxis in Patients on Beta Blockers
- Zlatan Coralic over at Academic Life in EM: My EpiPen Expired! Can I Still Use It?
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Emergency Physician at Greater San Antonio Emergency Physicians (GSEP)
Creator & Founder of R.E.B.E.L. EM