Anaphylaxis

Question 1

What is anaphylaxis?

Answer 1

life-threatening, systemic, hypersensitivity reaction characterised by sudden onset of life-threatening airway and/or breathing and/or circulation problems (with or without skin changes) after exposure to a trigger (allergen)

Question 2

What are resp features of anaphylaxis?

Answer 2

1. Shortness of breath
2. Stridor
3. Wheezing

Question 3

What are the circulation features of anaphylaxis?

Answer 3

1. Pale and clammy

2. Hypotension

Question 4

What are the skin/mucosal features of anaphylaxis?

Answer 4

1. Flushing
2. Urticaria
3. Angio-oedema

Question 5

What are common triggers?

Answer 5

foods, drugs, chemicals

Question 6

What are RF for anaphylaxis?

Answer 6

Hx of Atopy

Question 7

What is the patho of anaphylaxis?

Answer 7

1. Systemic mast-degranulation

2. Leads vessel dilation, increase vessel permeability, bronchospasm

Question 8

What investigations are done for anaphylaxis?

Answer 8

1. Medical emergency, treat as soon as possible!
2. A-E (with reassessment)
3. If uncertain elevated serum tryptase and plasma histamine

Question 9

What is the acute management of anaphylaxis?

Answer 9

• Help!
• Lie flat
• IM adrenaline

Question 10

What is the acute management of anaphylaxis with equipment?

Answer 10

1. High-flow oxygen (15 L/min via non-rebreathe mask)
2. Monitoring (pulse oximetry, ECG, BP)
3. IV fluid challenge
4. IM or slow IV Chlorphenamine and Hydrocortisone

Question 11

What are the aftercare management of anaphylaxis?

Answer 11

1. Observe
2. safety net
3. EpiPen
4. refer to allergy services

Question 12

What are possible complications of anaphylaxis?

Answer 12

1. Death
2. MI
3. Reccurence

Question 13

What is acute management?

Answer 13

1. CALL FOR HELP
2. Remove trigger e.g. antibiotic
3. Lie patient flat and elevate legs if possible
4. Adrenaline: one 500 microgram dose of 1:1000 intramuscular adrenaline (for adults
5. Reassess the airway – any immediate response? Still patent and unobstructed?

Question 14

What would u give to give fluids?

Answer 14

Ask your nurse colleague to place two wide-bore 18G cannula in each arm and then reassess

Question 15

What is the most common anaphylaxis?

Answer 15

Immunologic anaphylaxis

Question 16

What is the process of immunological anaphylaxis?

Answer 16

1. first time an allergen enters the system it interacts with the B cells and create IgE antibodies in response to the allergen
2. IgE docks onto mast cells
3. second time that the allergen enters the system it can immediately bind to the mast cells docked with the specific IgE antibodies and activates cytokines to produce WBCs and also release histamines.

Question 17

What does histamine do?

Answer 17

1. dilate blood vessels
2. cause leaky blood vessels
3. bronchospasm

Question 18

What does the dilated blood vessels mean?

Answer 18

drop in BP and lose function of circulatory system

Question 19

What does the leaky blood vessels cause?

Answer 19

fluid leaves the extracellular space, which causes swelling.

Question 20

What is non-immunological anaphylaxis?

Answer 20

1. similar but has a slightly different pathophysiology

2. instead of mast cells being stimulated by IgE, the allergen specifically targets the receptors on the mast cells

Question 21

If unsure what do you give and emergency?

Answer 21

IM ADENALINE