Investigations help to confirm diagnosis

BMJ 1995;311:1435 (25 November)

Letters

Investigations help to confirm diagnosis

EDITOR,--Malcolm Fisher's review highlights the need for adrenalinealong with volume replacement in the management of severe systemicanaphylaxis.¹ This observation was recognised by the Associationof Anaesthetists of Great Britain and Ireland, which in 1990produced a booklet for all members² and a wall chart for thetheatre area.

As Fisher states, cardiovascular collapse is a common featureof anaphylaxis, but, particularly in the context of surgery,it is not the only diagnosis that has to be considered: myocardialinfarction, pulmonary embolus, and concealed hypovolaemia aresome of the diagnoses that have to be excluded. The diagnosismay be unclear, especially if the patient dies. Furthermore,the management of an acute systemic anaphylaxis is stressful.Information is often not readily available about which investigationsto carry out or what to do with samples, so blood tests canbe spoiled or results misplaced. The relevant history and clinicalsigns may . . . [Full text of this article]