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ACRM > Anaphylaxis > Flashcards

Anaphylaxis Flashcards

1
Q

Anaphylaxis is what type of allergic reaction

A

Type 1, IgE-triggered

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2
Q

Anaphylactoid reactions are what type of allergic reaction

A

Type 1; non-IgE-triggered

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3
Q

Describe the physiology of anaphylaxis

A
  • exposure to antigen causes IgE antibodies to bind to surface of mast cells & basophils
  • repeat exposure to antigen causes binding to IgE antibodies
  • degranulation of mast cells and basophils
  • release of inflammatory mediators
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4
Q

Most important inflammatory mediators in an anaphylactic rxn

A
  • histamine
  • leukotriene
  • prostaglandin
  • tryptase
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5
Q

Key difference between anaphylactic & anaphylactoid rxns

A

anaphylactoid rxn = can occur on 1st exposure, does not depend on IgE antibodies to produce response

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6
Q

4 body systems affected in anaphylaxis

A

1) cutaneous (pruritis, flushing, angioedema)
2) resp (wheezing, SOB, increased airway pressures)
3) GI (N/V/D, abd pain, incontinence)
4) CV (HoTN, tachy, arrhythmias, shock)

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7
Q

What causes the vasodilation & increased capillary permeability associated with anaphylaxis?

A

histamine: H1 and H2 receptors –> HoTN

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8
Q

S/S in anesthetized patients experiencing anaphylaxis (triad)

A
  • cutaneous signs
  • CV collapse (HoTN)
  • bronchospasm/increased PIP/hypoxemia
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9
Q

Most common cause of perioperative anaphylaxis in Europe?

A

NMBAs

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10
Q

Most common cause of perioperative anaphylaxis in US?

A

antibiotics (B lactams: PCN & cephalosporins)

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11
Q

Highest to lowest NMBA anaphylaxis sensitivity

A

Succs > Roc > Cis/Atra > Pan > Vec

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12
Q

An anaphylactic rxn occurring 30-60min after incision is likely d/t…

A

latex

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13
Q

Risk factors for perioperative anaphylaxis

A
  • hx of a previous rxn
  • female
  • food allergies
  • seasonal allergies
  • multiple sxs
  • elderly w/ COPD/CAD
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14
Q

Goals of treating anaphylaxis:

A

1) stop administration of allergen
2) abate effects of toxic mediator release
3) prevent further mast cell degradation

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15
Q

T/F: Epi dose in anaphylaxis depends on severity

A

true

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16
Q

Grade 1 anaphylaxis symptoms and Epi dose

A

cutaneous signs only (erythema, urticaria, angioedema)

NO Epi

17
Q

Grade 2 anaphylaxis symptoms and Epi dose

A

cutaneous signs, HoTN, tachycardia, wheezing, difficult ventilation, N/V/D, abd pain

10-20mcg boluses

18
Q

Grade 3 anaphylaxis symptoms and Epi dose

A

life-threatening severity; CV collapse, profound HoTN, bradycardia, arrhythmias, bronchospasm, hypoxia, N/V/D, incontinence

100-200mcg boluses, +/- infusion

19
Q

Grade 4 anaphylaxis symptoms and Epi dose

A

cardiac/resp arrest

1mg + infusion @ 0.05-1.0 mcg/min

20
Q

2 most critical interventions for treating anaphylaxis:

A

1) IV fluids
2) Epi

21
Q

Effect of Epi on anaphylaxis processes:

A
  • A1: vasoconstriction, decreased permeability
  • B1: inotropy, chronotropy
  • B2: bronchodilation
  • inhibits mast cell degradation & release of mediators
22
Q

Medication options for anaphylaxis refractory to Epi

A
  • vasopressin
  • Dopamine, NE, Isuprel
  • Glucagon
  • Methylene blue
  • bronchodilators
  • antihistamines
  • corticosteroids (prevents late response)
23
Q

T/F: The order of medications administered is often predictive of the causative factor of anaphylaxis.

A

False

24
Q

T/F: Any med administered during the perioperative period can cause anaphylaxis.

A

True

25
Q

T/F: The majority of intraoperative anaphylactic rxns can occur during induction or maintenance of anesthesia.

A

True

26
Q

T/F: The most common symptoms of anaphylaxis are bronchospasm, CV collapse, and cutaneous signs.

A

True

27
Q

Relevance of tryptase to anaphylactic rxns

A
  • lab that should be drawn 45-90min after a suspected rxn
  • one of the main mediators released from mast cells & basophils
  • confirms dx of anaphylaxis
  • plasma levels increased 15min-2hrs after symptom onset
28
Q

Serum tryptase level indicative of anaphylaxis

A

> 11.4ng/mL

ACRM (9 decks)

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