Anaphylaxis is a life threatening hypersensitivity reaction that can cause shock. Epidemiology studies show anaphylaxis and anaphylactic shock is relatively rare, but its incidence is increasing. A review of the pathophysiology of anaphylaxis can provide insight into clinical decisions. Diagnosing anaphylaxis can be difficult as symptoms and history are not always obvious. Diagnostic guidelines provide an objective tool to assess for anaphylaxis. Early intervention during anaphylaxis may prevent development of shock. Management is focused on circulation support with epinephrine and IV fluids, and airway maintenance. Following an acute anaphylactic reaction, patients should be provided with a referral for follow up and educated on avoidance of triggers and use of epinephrine autoinjectors.
This chapter explores how integrating holistic and reductionistic approaches to care may better optimize value based care. First, we define the terms 'Holistic,' 'Reductionistic' and 'Integrative'. Then we explore their scope in the arenas of teaching and patient care, with the advantages, disadvantages and pitfalls of each approach. We review how these styles are embedded in and interact with the cultures of medicine and western societies at large. As an example of a balanced care approach, we focus on the example of chronic low back pain (CLBP), an increasingly common and expensive medical problem. We present practical examples of teaching and practicing these different styles, Holism and Reductionism, illustrating when each may be appropriate to optimize value of patient care. Study questions are included. A list of further readings and resources is included for the interested reader.
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