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Emergency Medicine > Anaphylaxis > Flashcards

Anaphylaxis Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Anaphylaxis is Ig____-mediated reaction

A

IgE

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2
Q

Which cells are responsible for Anaphylaxis?

A

Mast Cells and Basophils

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3
Q

Children MC get anaphylaxis from what?

A

Foods -> nuts, fruit, milk, eggs, shellfish, fish

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4
Q

Adults MC get anaphylaxis from what?

A

Bees and wasps

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5
Q

MC causes of anaphylaxis overall?

A
  • Foods -> nuts, fruit, milk ,eggs, shellfish, fish
  • Bees and Wasps
  • Meds -> ABX, NSAIDs, Aspirin
  • Animal venoms, latex, proteins (teatnus antitoxin, blood transfusions)
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6
Q

Which vaccines have a higher risk of anaphylaxis?

A
  • flu
  • MMR
  • Yellow Fever
  • Tetanus
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7
Q

What are the immune-complex mediators?

A
  • Whole blood
  • Plasma
  • Dialysis Membranes
  • Immunoglobulins
  • Gamma Globulin
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8
Q

What are the non-immunologic activators that may cause anaphylaxis?

A

Opiates
Radiopaque contrast dye
ACE-I
ABX: Vancomycin, Aminoglycosides

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9
Q

How does a Hx of Atopy affect anaphylaxis?

  • incr risk of anaphylaxis?
  • incr death when anaphylaxis occurs?
A

It does NOT increase risk of anaphylaxis, but it does increase risk of DEATH when anaphylaxis occurs

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10
Q

Anaphylactoid Rxns vs Anaphylactic Rxns

A

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

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11
Q

Which Anaphylaxis triggers has the highest reported deaths per year?

A

B-lactam ABX

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12
Q

Anaphylaxis affects which organ systems?

A

Skin, Resp, Cardio, GI

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13
Q

Anaphylaxis increases vascular permeability and causes which SS?

A
  • Urticaria
  • Angioedena
  • Larygneal Edema
  • Nasal Congestion
  • GI Cramping/Vomiting
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14
Q

Initially, do CHILDREN present with trouble breathing or flushing/itchiness?

A

Trouble breathing

Resp -> then skin

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15
Q

Initially, do ADULTS present with trouble breathing or flushing/itchiness?

A

Initially, adults get flushing/itchiness

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16
Q

Rapid PE Assessment

A
  • 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
17
Q

Non-pharm trmnt

A
  • Airways - intubate, ventilate
  • High flow O2
  • Cardiac monitor + pulse ox
  • IV access (large bore)
  • Fluid Bolus for HypoTN or Tachy
    Supine position
18
Q

Mild cases of anaphylaxis can be confirmed by measuring _____ or _____

A
  • 24-hour urinary levels of N-methylhistamine
  • Serum levels of Tryptase
19
Q

What to do if pt with anaphylaxis is hypotensive or tachy?

A

give IV Fluid bolus
peds: 20mg/kg
Adults: 1L

20
Q

should IV fluids be given bolus or drip if pt shows hypoTN or Tachy?

A

BOLUS

21
Q

IV Fluid Bolus dosage for peds and adults

A

peds: 20mg/kg
Adults: 1L

22
Q

trmnt for anaphylactic shock

A

Epi
Benadryl
Albuterol +/- Ipratropium bromide nebulizer
Methylprednisone

23
Q

Epi MOA

A

Alpha Agonist - further vasoconstricts smooth muscle and keeps everything from leaking out
B1 Agonist - further excites the heart
B2 Agonist - further bronchodilates the lungs

24
Q

when to give epi IM vs IV?

A

normally IM
IV for severe cardiac symp or SHOCK

25
Q

if you give epi racemic nebulizer for laryngeal swelling, should you still give IM injection?

A

yes

26
Q

Does using both a H1RB and H2RB lessen then their effectiveness?

A

NO, they actually work better when used together

27
Q

Which histamine receptor blocker do you use?

A

H1RB Benadryl
H2RB famotidine

28
Q

Benadryl dosing

A

Adults: 50 mg IV or IM
Peds: 1 mg/kg IV

29
Q

Famotidine dosing

A

Adults: 20mg IVP
Peds: 0.25mg/kg, not to exceed adult dose

30
Q

Corticosteroid MOA

A

potent inhibitors of inflammatory processes and potent anti-allergic compounds reducing the number, maturation and activation of mast cells

31
Q

Pt is on BB and giving Epi doesnt seem to do shit. What now?

A

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.

32
Q

Warn the nurse to push glucagon bolus SLOW or else what?

A

pt may vomit. if so, turn them on their side slightly

33
Q

What med is the last resort and why?

A

Magnesium (smooth muscle relaxer) is last resort bc it can counteract with epi and cause hypoTN

34
Q

Mild cases of anaphylaxis can be confirmed by measuring _____ or _____

A
  • 24-hour urinary levels of N-methylhistamine
  • Serum levels of Tryptase

Emergency Medicine (11 decks)

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