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In Dutch: a local guideline anafylactic reactions

14 Apr

Hi all,

Attached the local guideline anaphylactic reactions in Dutch from Elisabeth hospital, Tilburg, with thanks to Pieter van Driel.

A while ago some of us had an email discussion about treatment, especially the role of epinephrine, and when to administer it.

Would you mind sharing your local protocols with us on this website? Please contact us by mail, see homepage.

Cheers, Laura


Protocol anafylaxe definitief.2014

P2Y12 receptor inhibitors in ACS

22 Jul

The cornerstone of treatment of ACS in the ED is aspirin, anticoagulation and P2Y12 receptor inhibitors. It is in the guidelines, but still it is interesting to look at the evidence behind the guidelines! Just read the article in BMJ called: “Why we can’t trust clinical guidelines

Today we dive into the evidence of  P2Y12 receptor inhibitors for ACS. The ones we look at are clopidogrel, prasugrel and ticagrelor! And just so you know, I have no conflict  of interest!!!

Here is the table with the articles:

Table P2Y12

PSA conform CBO richtlijn (Egmond aan Zee 2013)

2 Jul

Voor degene die er niet bij aanwezig waren dit jaar, of het graag nog een keer willen zien/horen:

de presentatie van Gael Smits (SEH-arts in Catharina Ziekenhuis, Eindhoven) m.b.t. PSA conform de CBO richtlijn 2012. Gael is betrokken geweest bij de CBO-richtlijn en bespreekt interessante items.

De ppt + audio (duur 20 min) staat hieronder.  

Sit, relax and learn stuff:

Presentatie PSA (Gael Smits) 7th Dutch North Sea Emergency Medicine Conference, juni 2013


“Coagulation & Medications” – Aspirin

9 May

This is aspirin, credit to Bayer for discovering it!

I already was a big fan of #FOAMed and the different EM blogs out there, but working on this post made me even a bigger fan! It is impossible for me to discuss all the anticoagulation and antiplatelets, their purposes and the evidence for their use. It would probably take me years and me my relationship. That’s why a great part of this post is “borrowed” from others and a lot with be cardiology minded. In the end we also need to discuss thrombolytics in acute ischemic stroke. But today is about Aspirin, followed by posts about the other antiplatelets and one about anticoagulation!

ASPIRIN… aka acetylsalicylic acid (ASA). It is the best known antiplatelet out there! It is a COX-inhibitor, which inhibits the activation of platelets. I will discuss the evidence behind the use of aspirin in Acute Coronary Syndrome (ACS). Other reasons to use it, like ischemic stroke or Kawasaki disease won’t be discussed here.

Up till the beginning of the 90’s the spectrum of ACS was different than it is nowadays. It consisted of UA, Non-Q wave MI (NQMI) and Q wave MI (QwMI). Then came the meta-analysis FTT (Fibrinolytic Therapy Trialist), which found that the patients with ST-elevation benefit from fibrinolytics. After this the spectrum became UA and (N)STEMI.

So why all this (old) information, you think? Well, this means that older articles (from the 90’s and before) classified the patients with ACS differently than we do nowadays, which may lead to differences in results. For example, somebody with a STEMI back than could initially be in the UA group.

The article that looked at aspirin in acute MI was ISIS-2 in 1988. ISIS­2: Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17187 cases of suspected acute myocardial infarction. Lancet. 1988 Aug 13;2(8607):349-60. This article is discussed on the website: theNNT:

This is what they did and found:

Continue reading


12 Mar

FINALLY….Where you have all been waithing for the last couple of months….FLIPPING THE GUIDELINE OF THE SYMPATHETIC CRASHING ACUTE PULMONARY EDEMA (SCAPE)! (In the Netherlands we call this “cardiac asthma” by the way.) We started on december the 16th, 2012 and today, almost 3 months later, it is time to flip it!

Here is the ESC Guideline on AHF of 2012:

ESC guideline 2012 AHF

So in short this means:
1.) Diuretics and when hypoxic give O2.
2.) Consider i.v. opiates for anxiety/distress
3.) Consider NTG. (Since we are talking about SCAPE it means SBP>110 mmHg)
4.) If good response  Continue treatment, if not, re-evaluate.
5.) Consider NIV when SpO2<90%

Now it’s time for the EMDutch Guideline for SCAPE:

Continue reading