ABSTRACT
Cardiopulmonary resuscitation prioritises treatment for cardiac arrests from a primary cardiac cause, which make up the majority of treated cardiac arrests. Early chest compressions and, when indicated, a defibrillation shock from a bystander give the best chance of survival with a good neurological status. Cardiac arrest can also be caused by special circumstances, such as asphyxia, trauma, pulmonary embolism, accidental hypothermia, anaphylaxis, or COVID-19, and during pregnancy or perioperatively. Cardiac arrests in these circumstances represent an increasing proportion of all treated cardiac arrests, often have a preventable cause, and require additional interventions to correct a reversible cause during resuscitation. The evidence for treating these conditions is mostly of low or very low certainty and further studies are needed. Irrespective of the cause, treatments for cardiac arrest are time sensitive and most effective when given early-every minute counts.
Subject(s)
Anaphylaxis/therapy , Asphyxia/therapy , Cardiopulmonary Resuscitation/methods , Heart Arrest/therapy , Hypothermia/therapy , Pregnancy Complications, Cardiovascular/therapy , Pulmonary Embolism/therapy , Wounds and Injuries/therapy , Anaphylaxis/complications , Asphyxia/complications , COVID-19/complications , COVID-19/therapy , Electric Countershock , Female , Heart Arrest/etiology , Humans , Hypothermia/complications , Intraoperative Complications/therapy , Out-of-Hospital Cardiac Arrest/etiology , Out-of-Hospital Cardiac Arrest/therapy , Personal Protective Equipment , Postoperative Complications/therapy , Practice Guidelines as Topic , Pregnancy , Pulmonary Embolism/complications , Return of Spontaneous Circulation , SARS-CoV-2 , Wounds and Injuries/complicationsABSTRACT
The SARS-CoV2 pandemic has prompted a re-evaluation of our current practice of medicine. The seemingly abrupt worldwide spread of this disease resulted in immediate changes and a reduction in many allergy-focussed services and procedures. The reality of the long-term circulation of this virus in our communities requires us to evolve as a specialty. In this article, we outline current and future challenges in the management of food allergy in light of coronavirus disease 2019 (COVID-19). We focus on infant food allergy prevention, management of anaphylaxis, accurate diagnosis with oral food challenges, and active management of food allergy with oral immunotherapy. This article identifies the challenges of conflicting guidelines, shortcomings of acute management approaches, and inherent system deficiencies. We offer perspectives and strategies that can be implemented now, including an evaluation of virtual care and telemedicine for the management of food allergy. The use of a shared decision-making model results in novel approaches that can benefit our patients and our specialty for years to come. COVID-19 has forced us to re-evaluate our current way of thinking about food allergy management to better treat our patients.