ACT Emergency Flashcards
Description of anaphylaxis
Anaphylaxis is a life threatening Type 1 hypersensitivity reaction. There is IgE mediated release of histamine from mast cells in response to a presensitised allergen. The cascade release of inflammatory cytokines increases capillary permeability causing oedema.
Aetiology of anaphylaxis
Exposure to an allergen such as a food or drug, presensitises individuals. When there is subsequent exposure, IgE activation of mast cells causes a type 1 hypersensitivity reaction.
Complications of anaphylaxis
The resulting swelling can occlude the patients airway.
Fluid shift out of the intravascular space can cause a distributive shock.
Assessment of suspected anaphylaxis
A to E approach - Full set of Observations
Dx- Acute onset, Life threatening ABC problem and/or skin changes
Check drug chart
Ask ward staff for recent medications
Immediate management of anaphylaxis
Stop allergen exposure Call for Help Lie flat + Legs up Adrenaline 1:1000 500micrograms IM Establish airway + 15L non-rebreathe IV access - Mast cell tryptase, FBC, U&Es \+/- Fluid challenge Chlorphenamine 10mg slow IV Hydrocortisone 200mg slow IV
Investigations for anaphylaxis
Bloods: FBC, U&Es
Serum Mast cell tryptase x 3: up to 1 hr, at 3hr and 24 hrs
Diagnosis will show a peak then return to normal by 24hrs
Explanation of anaphylaxis to patient
Anaphylaxis is a type of severe allergic reaction which occurs when the body comes into contact with something the immune system has become sensitive to.
It can be caused by many things including foods such as nuts and shellfish or drugs such as antibiotics
Symptoms can include a rash with itching and tingling, swelling of the lips and tongue and difficulty breathing.
Long term management of anaphylaxis
Follow up appointment with immunologist for:
Patient education
Rx of Epipen and training
Differential diagnosis for anaphylaxis
Carcinoid syndrome - paraneoplastic release of serotonin
Phaeochromocytoma - neuroendocrine tumour of adrenal medulla secreting catecholamines
Description of septic shock
Sepsis with hypotension and a lactate > 2mmol/L despite adequate fluid resuscitation.
The patient needs vasopressors to maintain a mean arterial pressure of 65mmHg
Aetiology of septic shock
There is loss of vascular tone following a systemic inflammatory response to pathogenic toxins.
Fluid shift out of the intravascular space causes a drop in blood pressure.
Complications of shock
Hypo-perfusion of end organs can lead to schema and dysfunction. If prolonged can lead to multiple organ failure and death
Management of septic shock
A to E - BUFALO
Call for senior help
Requires ICU Early Goal Directed Therapy
Vasopressors to maintain mean arterial pressure >65mmHg
Description of cardiogenic shock
A state of end-organ hypoperfusion due to cardiac failure and the inability of the cardiovascular system to provide adequate blood flow to the extremities and vital organs
Aetiology of cardiogenic shock
True cardiac - MI, arrhythmia, valve failure
Extracardiac - Obstructive
Prevent inflow- Tension pneumothorax, Tamponade
Prevent outflow - Pulmonary embolus
Assessment and investigations for suspected cardiac shock
A to E
ABG, CXR,
Bloods - FBC, U&E, Glucose, clotting, crossmatch
ECG, Echocardiogram
Management of cardiogenic shock
A to E
Treat the underlying cause eg. Revascularisation
Cautious fluid resuscitation - 250ml
Early ICU involvement - inotropes and vasopressors
Description of hypovolemic shock
Insufficient circulating volume in the intravascular space to adequately perfuse end organs due to fluid loss
Aetiology of hypovolemic shock
Haemorrhage - On the floor and 4 more
Chest, Abdomen, Pelvis, Long bones.
Salt or fluid loss - Vomiting, Diarrhoea
Third spacing - Ascities
Assessment and investigation of suspected hypovolemic shock
A to E ABG - ?DKA ?Pancreatitis CXR - ?Haemothorax Bloods - FBC, U&E, LFT, Amylase, Coag, X-match ECG - ischaemia FAST Scan - ruptured AAA Pelvic x-ray - fractures
Urine Osmolality - Diabetes insipidus
Stool MC&S
