(3) An unpleasant surprise

Question 1

Signs and symptoms of anaphylaxis?

Answer 1

• Red urticarial rash (pale red, raised, itchy bumps)
• Edema
  
  • Obstruct airways
• Hypotension
  
  • Reduced peripheral resistance
• Hypovolemia
  
  • Movement of fluid out of circulation into the tissues
• Small airways obstruction
  
  • Edema and bronchospasm

Question 2

What to do immediately following anaphylaxis?

Answer 2

• Reassure the patient
• Assess the vital signs including blood pressure, pulse, and respiratory rate
• Lie the patient flat (if no difficulty in breathing)
• Call for help
• Obtain oxygen + emergency drug box

Question 3

What are the adverse physiological effects of anaphylaxis?

Answer 3

• Vasodilation
• Increased capillary permeability
• Bronchospasm

Question 4

What are two factors that may account for delayed onset of anaphylaxis?

Answer 4

• Nature of the allergen
• Route of exposure

Observe for an hour after adminstration of AB cover

Question 5

Treatment for anaphylactic effects becoming more severe include:

Answer 5

1. Adrenaline (epinephrine)
   
   1. Anterolateral aspect of middle of the thigh
   2. Deltoid muscle
   3. No more than two dose of adrenaline (5 min gap if worsening condition) should be necessary following adminstration of chlorphenamine
2. Chlorphenamine
   
   1. 10 mg intravenously
   2. Counters histamine
3. Hydrocortisone
   
   1. 100 - 200 mg intravenously/intramuscularly
4. Intravenous fluid
   
   1. (hypotension)

Question 6

Procedure for anaphylaxis after patient recovers after drug adminstration?

Answer 6

1. Abandom dental treatment
2. Continue monitoring vital signs
3. Continue adminstering oxygen
4. Arrange transfer of the patient to an appropriate secondary care facility
5. Advise the patient of the need for formal investigation of probable allergy

Question 7

Physiological effet of adrenaline (epinephrine):

Answer 7

• Alpha receptor agonist
  
  • Vasoconstriction (reverses edema)
• Beta receptor agonist
  
  • Beta 1
    
    • Increased cardiac output by increasing contraction force + heart rate
  • Beta 2
    
    • Bronchodilation
• Suppress mast cell degranulation

Question 8

Reason for high risk of anaphylaxis?

Answer 8

• History of hypersensitivity to other allergen-mediated conditions (e.g. asthma, eczema)

Important to take a thorough allergy history

Question 9

What is a safe alternative antibiotic that can be taken?

Answer 9

• Clindamycin

Question 10

• When should adrenaline (epinephrine) be administered?

Answer 10

• Immediately when signs begin to develop