Acute Care Committee Flashcards
What is the dose of epinephrine when you are worried about an anaphylactic reaction?
IM Epinephrine (1:1000) given 0.01 mg/kg Give immediately and then every 5-15 minutes as required
What are your considerations in your ABCs of a child in anaphylaxis?
NB: Concurrent administration of IM epinephrine during assessment A: Look for signs of upper airway obstruction or severe respiratory distress - think about early preparation of definitive airway management B: Supplemental O2 C: Full cardioresp monitoring, 2 large bore IVs - Aggressive fluid resuscitation if there is cardiac involvement - Trendelenburg position to optimize venous return
Why are H1 and H2 antihistamines second line treatments for anaphylaxis?
Although they are mainstay treatments for minor allergic reactions, they are second line for anaphylaxis because they have a slow onset of action and have limited effect on symptoms
When should ventolin be considered in the management of anaphylaxis?
Children who present with bronchospasm and wheezing, or who have a history of asthma may benefit from inhaled ventolin as part of their anaphylaxis treatment until wheezing or resp distress improves
When should inhaled epinephrine be considered in the management of anaphylaxis?
Stridor: patients may benefit from inhaled epi (no documented clinical efficacy); so IM epi remains the first line treatment for upper and lower airway obstruction due to anaphylaxis
What is the role of glucagon in the management of anaphylaxis?
Patients regularly taking beta-blockers who present with anaphylactic shock may have persistent hypotension despite epinephrine administration. In this situation, glucagon, which activates adenylate cyclase independent of the beta-receptor, may be given in an attempt to reverse the cardiovascular effects of anaphylaxis
How long should patients be observed/monitored for after an anaphylactic reaction?
Patients should be monitored for the first 4-6 hours after initial observation, but can occur up to 72 hours after initial presentation.
How many children with anaphylactic reactions get late-phase symptoms (a biphasic reaction)?
5-20% of patients Biphasic reaction = recurrence of anaphylactic symptoms after initial resolution, occurring anywhere from 1-72 hours after first symptom onset
What are high risk features that may make you want to observe a child who had an anaphylactic reaction overnight or consider for admission?
- Peanut allergy/Asthma 2. Use of beta blockers
When do you give IV epinephrine to a child in anaphylaxis?
When they become hypotensive or require repeated IM epinephrine
What is acute gastroenteritis typically caused by?
Viruses (Norovirus or Rotavirus)
What are five worrisome adverse effects of antiemetic drugs?
- Drowsiness 2. Extrapyramidal reactions 3. Hallucinations 4. Convulsions 5. Neuroleptic malignant syndrome
What type of medication is Ondansetron?
Selective Serotonin 5-HT3 Receptor antagonist
What’s the most common side effect of ondansetron in the setting of acute gastroenteritis?
Diarrhea
Based on studies, oral ondansetron has been found to be useful or beneficial in what setting?
Oral ondansetron therapy, as a single dose for paediatric gastroenteritis, is effective in reducing the frequency of vomiting and IV fluid administration in infants and children six months to 12 years of age who present to the ED with mild to moderate dehydration or who have failed a trial of oral rehydration therapy.
