Anaphylaxis Flashcards
Anaphylaxis is Ig____-mediated reaction
IgE
Which cells are responsible for Anaphylaxis?
Mast Cells and Basophils
Children MC get anaphylaxis from what?
Foods -> nuts, fruit, milk, eggs, shellfish, fish
Adults MC get anaphylaxis from what?
Bees and wasps
MC causes of anaphylaxis overall?
- Foods -> nuts, fruit, milk ,eggs, shellfish, fish
- Bees and Wasps
- Meds -> ABX, NSAIDs, Aspirin
- Animal venoms, latex, proteins (teatnus antitoxin, blood transfusions)
Which vaccines have a higher risk of anaphylaxis?
- flu
- MMR
- Yellow Fever
- Tetanus
What are the immune-complex mediators?
- Whole blood
- Plasma
- Dialysis Membranes
- Immunoglobulins
- Gamma Globulin
What are the non-immunologic activators that may cause anaphylaxis?
Opiates
Radiopaque contrast dye
ACE-I
ABX: Vancomycin, Aminoglycosides
How does a Hx of Atopy affect anaphylaxis?
- incr risk of anaphylaxis?
- incr death when anaphylaxis occurs?
It does NOT increase risk of anaphylaxis, but it does increase risk of DEATH when anaphylaxis occurs
Anaphylactoid Rxns vs Anaphylactic Rxns
Anaphylactoid Rxns are clinical indistinguishiable from anaphylaxis, but does not involve IgE and does not require prior sensitization.
They occur via direct stimulation of mast cells or via immune complexes that activate compliment system
Anaphylactoid Rxns
Direct mass cell stim
Immune complexes -> Compliment
Triggers: Iodine contrast, NSAIDs, Aspirin, Opiods, Monoclonal Antibodies, Exercise
Anaphylaxis
IgE
Req prior sensitization
Triggers: food, bees, wasps, meds
Which Anaphylaxis triggers has the highest reported deaths per year?
B-lactam ABX
Anaphylaxis affects which organ systems?
Skin, Resp, Cardio, GI
Anaphylaxis increases vascular permeability and causes which SS?
- Urticaria
- Angioedena
- Larygneal Edema
- Nasal Congestion
- GI Cramping/Vomiting
Initially, do CHILDREN present with trouble breathing or flushing/itchiness?
Trouble breathing
Resp -> then skin
Initially, do ADULTS present with trouble breathing or flushing/itchiness?
Initially, adults get flushing/itchiness
Rapid PE Assessment
- General Appearance and Vital Signs: distress?
- Lungs: BS absent or wheezing? Swollen airways? Hoarse/Loss of voice?
- Heart: tachy, hypotensive, signs of shock?
- Neuro: mentation change, combative?
- GI: V/D, abdominal distention
Non-pharm trmnt
- Airways - intubate, ventilate
- High flow O2
- Cardiac monitor + pulse ox
- IV access (large bore)
- Fluid Bolus for HypoTN or Tachy
Supine position
Mild cases of anaphylaxis can be confirmed by measuring _____ or _____
- 24-hour urinary levels of N-methylhistamine
- Serum levels of Tryptase
What to do if pt with anaphylaxis is hypotensive or tachy?
give IV Fluid bolus
peds: 20mg/kg
Adults: 1L
should IV fluids be given bolus or drip if pt shows hypoTN or Tachy?
BOLUS
IV Fluid Bolus dosage for peds and adults
peds: 20mg/kg
Adults: 1L
trmnt for anaphylactic shock
Epi
Benadryl
Albuterol +/- Ipratropium bromide nebulizer
Methylprednisone
Epi MOA
Alpha Agonist - further vasoconstricts smooth muscle and keeps everything from leaking out
B1 Agonist - further excites the heart
B2 Agonist - further bronchodilates the lungs
when to give epi IM vs IV?
normally IM
IV for severe cardiac symp or SHOCK
if you give epi racemic nebulizer for laryngeal swelling, should you still give IM injection?
yes
Does using both a H1RB and H2RB lessen then their effectiveness?
NO, they actually work better when used together
Which histamine receptor blocker do you use?
H1RB Benadryl
H2RB famotidine
Benadryl dosing
Adults: 50 mg IV or IM
Peds: 1 mg/kg IV
Famotidine dosing
Adults: 20mg IVP
Peds: 0.25mg/kg, not to exceed adult dose
Corticosteroid MOA
potent inhibitors of inflammatory processes and potent anti-allergic compounds reducing the number, maturation and activation of mast cells
Pt is on BB and giving Epi doesnt seem to do shit. What now?
BB + Epi = PEMDAS
give Glucagon IV bolus over 5 min +/- titrated infusion
If epinephrine is ineffective in treating anaphylaxis in patients taking b-blockers, then glucagon administration might be necessary. Glucagon can reverse refractory bronchospasm and hypotension during anaphylaxis in patients on b-blockers by activating adenyl cyclase directly and bypassing the b-adrenergic receptor.
Warn the nurse to push glucagon bolus SLOW or else what?
pt may vomit. if so, turn them on their side slightly
What med is the last resort and why?
Magnesium (smooth muscle relaxer) is last resort bc it can counteract with epi and cause hypoTN
Mild cases of anaphylaxis can be confirmed by measuring _____ or _____
- 24-hour urinary levels of N-methylhistamine
- Serum levels of Tryptase
