Case: A 26-year-old woman (gravida 2, para 1) at 25 weeks' gestation was brought to the emergency department because of anaphylactic symptoms. She reported eating Japanese soba and developed symptoms of dyspnea, generalized itchy rash, abdominal pain, and severe uterine contractions within 15-30 min of eating. She was immediately treated by normal saline infusion, two injections of epinephrine (intramuscularly), and a nebulized short-acting b 2 -receptor agonist, followed by H 1 -antihistamine and methylprednisolone. Obstetrical management was undertaken by an obstetrician.Outcome: The patient recovered rapidly without a biphasic reaction of anaphylaxis. After 11 weeks, a healthy, neurologically intact baby was born.Conclusion: Management of anaphylaxis in pregnant patients is basically the same of that in non-pregnant ones. Treatment should commence immediately to prevent further development of the anaphylaxis reaction and fetal neurological deficiency.
Background: Early Periodic Screening, Diagnosis, and Treatment visits are designed to address physical, mental, and developmental health of children enrolled in Medicaid.Methods: We conducted a mixed methods intervention by using a quality improvement theory. We assessed preintervention and postintervention screening rates of development, anemia, lead, oral health, vision and hearing, interventions for improvement, and barriers for the well-child visits at an academic family medicine clinic. For quantitative analysis, we assessed the preintervention baseline for 183 children and postintervention outcome for 151 children. For qualitative analysis, we used group interviews and key informant interviews to develop interventions in the preintervention stage and to explore potential barriers for further improvement in the postintervention stage.Results: Interventions based on baseline results included user-friendly materials, checklists, posters, education, and order sets. After the intervention, there were significant statistical improvements (P < .05) for the anemia test ordered rate, serum lead test ordered rate, oral health screening and referral rates, and ordered and confirmed test rates for both vision and hearing. Despite these improvements, 3 qualitative findings indicated barriers for further improvement, including difficulties in venipuncture, medical assistant aversion to vision screening, and poor fit of equipment for hearing assessment. The procedures prompted further continuous quality improvement activities using fingerstick hemoglobin testing, a child-friendly vision screener, and manual audiometer with headphones.Conclusions: The trial findings demonstrated potential benefits of improving screenings in an officebased intervention by using a quality improvement process. Postintervention qualitative findings illustrate additional factors that could be addressed for further improvements. (J Am Board Fam Med 2018; 31:558 -569.)
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