Anaphylaxis

Question 1

What is the mechanism behind anaphylaxis?

Answer 1

IgE stimulates rapid release of histamine and other pro-inflammatory chemicals from mast cells in mast cell degranulation, causing AW, breathing and/or cirulation compromise

Question 2

Why do children have to be monitored carefully after an anaphylactic attack?

Answer 2

Biphasic reactions danger - 2nd reaction after successful treatment of first

Question 3

How is anaphylaxis confirmed after management?

Answer 3

Serum mast cell tryptase within 6 hours of events

Question 4

What to check when initially see someone with anaphylaxis?

Answer 4

Responsiveness/breathing - do they require CPR

Question 5

If someone with anaphylaxis does not require CPR what check next

Answer 5

Chest - signs of lower and upper AW obstruction
Check pulse and BP for signs of circulatory collapse
Check skin inseide moth for urticaria and angio-oedema

Question 6

Why must someone with anaphylaxis lie down and not stand up or sit up quickly>

Answer 6

Fatality can occur within minutes
Sit in semirecumbent position
Increase cerebral perfusion

Question 7

When can you put someone with anaphylaxis in the recovery position?

Answer 7

When people are breathing normally but uncosncours

Question 8

Why do pregnant women have to be put into the recovery position on their left?

Answer 8

Aortocaval compression

Question 9

What is the dose for IM adrenaline for adults or children over 12 years old?

Answer 9

500 micrograms

Question 10

What no longer recommended in emergency anaphylaxis

Answer 10

Antihistamines

Question 11

Are steroids recommended in anaphylazis

Answer 11

NO - just fluid and adrenaline in emergency
If later -
Slow IM or IV 200mg

Question 12

What is the emergency dose of adrenaline for children 6-12 years old?

Answer 12

1:1000, 300 micrograms - 0.3mL

Question 13

oop

Answer 13

5mg

Question 14

lord

Answer 14

100mg

Question 15

Nebulised salbutamol dose in children over 6 years to adults

Answer 15

5mg

Question 16

Salbutamol nebulised emergency dose 6 months to 6 years

Answer 16

2.5 mg

Question 17

Adrenaline emergency dose for child 6 months to 6 years

Answer 17

150 micrgrams of 1:1000

Question 18

Children undre 6 months emergency dose of adrenaline

Answer 18

100-150 micrograms of 1:1000

Question 19

lol

Answer 19

2.5mg slow IM/IV

Question 20

nope

Answer 20

25mg

Question 21

nope

Answer 21

250 micrograms/kg

Question 22

What is the best sized needle for adrenaline administration?

Answer 22

25mm needle at right angle to skin, strethced not bunched

Question 22

What is the best sized needle for adrenaline administration?

Answer 22

25mm needle at right angle to skin, strethced not bunched

Question 23

What should you recognise anaphylaxis from?

Answer 23

sudden onset and rapid progression of symptoms
Airway and/or Breathing and/or Circulation problems
skin and/or mucosal changes (flushing, urticaria, angioedema)

Question 24

Where give IM adrenaline?

Answer 24

Anterolateral thigh

Question 25

When do yuo repeat IM adrenaline in anaphylaxis?

Answer 25

5 minutes and ABC problems persist

Question 26

When do you seek expert help in anaphylaxis?

Answer 26

Respiratory and/ore cardiovascular problems persist depite 2 doses of IM adrenaline -> iv ADRENALINE infusions

Question 27

What skin/mucosal changes are ass with anaphylaxis?

Answer 27

flushing, urticaria, angioedema

Question 28

When are IV fluids recommended for anaphylaxis?

Answer 28

Always
Esp in Refractor anaphyaxis, early in shock and hypotension

Question 29

What treatment is third line and should not be used in ABC initial emergency management?

Answer 29

Antihistamines and steroids

Question 30

What meds are no longer advised for routine emergency treatment of anaphylaxis?

Answer 30

Corticosteroids

Question 31

IV fluid challenge amount in adults vs children?

Answer 31

Adult - 500-1000ml
Child - 10mL/kg

Question 32

Signs of life threatening problems with AW

Answer 32

Hoarse voice, stridor

Question 33

Breathing - signs of life threatening problems

Answer 33

Increased work of breathing, wheeze, fatigue, cyanosis, So02, <94%

Question 34

Steps in emergency anaphylaxis

Answer 34

A-E assess
Call for help
Remove trigger. lie flat
IM adrenaline
Establish airflow, highlow oxygen
Monitoring - ECG, BP, pulse oximetry

Question 35

Symptoms of anaphylaxis

Answer 35

• Urticaria
• Itching
• Angio-oedema, with swelling around lips and eyes
• Abdominal pain
• Shortness of breath
• Wheeze
• Swelling of the larynx, causing stridor
• Tachycardia
• Lightheadedness
• Collapse
  -Changes in bowel habit

Question 36

What is important to cover after anaphylaxis in a child?

Answer 36

Educate child and parent on trigger, how to avoid and spot signs
Parents - trained in BLS and how to use adrenaline autoinjector

Question 37

What are trade names of adrenalin autoinjectors?

Answer 37

Epipen, Jext, Emerade

Question 38

What risk factors are present for autoadrenaline epipens to be given out for allergic reactions that dont cause anaphylaxis?

Answer 38

Asthma requiring inhaled steroids
Poor access to medical treatment eg rural locations
Adolescenets (higher risk)
Nut or insect sting allergies
Significant co-morbidities eg cardiovascular disease

Question 39

How to use an adrenalin autoinjector?

Answer 39

Prepare device - remove safety cap (blue or yellow, non needle end)
Grip the device in fist needle down
Administer injection - firmly jab by device into outer portion mid thigh until clicks
3s for EpiPen, 10s (Jext)
Remove device and massage area for 10 seconds