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Acute Care > Anaphylaxis > Flashcards

Anaphylaxis Flashcards

1
Q

what is anaphylaxis

A

hypersensitivity reaction type 1

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2
Q

how many types of hypersensitivity reactions is there

A

4 types

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3
Q

type 1

A

IgE AB mediated- targeting allergen

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4
Q

Type 2

A

IgM and IgG AB mediated- targeting “self” Ag

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5
Q

Type 3

A

Immune complex mediated

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6
Q

Type 4

A

CD4+ and CD8+ mediated

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7
Q

Type 1 hypersensitivity reaction - Allergic reaction steps

A
  1. first exposure to environmental allergen (an other harmless antigen)- inhaled, ingested, injected, direct contact
  2. predisposed individual- Naive B- lymphocyte induced to produce IgE AB
  3. sensitization- IgE AB bind to surface of Mast cells and Basophils
  4. Re-exposure to the allergen
  5. Reaction- degranulation of mast cells and basophils with release of performed chemical mediators- Histamine, leukotrienes, prostaglandins and others, resulting in a number of effects
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8
Q

spectrum of type 1

A

Mild- Severe
Local- systemic

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9
Q

what is anaphylaxis

A

it is an acute, severe, life- threatening allergic reaction that is generalized/ systemic (multi organ), that occurs within seconds to minutes to hours to exposure to a known, or unknown, allergen. it may also be biphasic

anaphylaxis involves multiple systems

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10
Q

organs which anaphylaxis usually occur at

A
  1. skin and or mucosa (80%)
  2. respiratory system
  3. cardiovascular system
  4. gastrointestinal system
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11
Q

skin and or mucosa: superficial symptoms

A

flushing
urticaria (pruritic skin rash)
conjunctival injection
rhinorrhea

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12
Q

skin and or mucosa: deep symptoms

A

angiodema (painless swelling under the skin, commonly of the tongue, lips and peri-orbital region)

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13
Q

respiratory system: upper airway obstruction (pharynx ,larynx)

A

visual swelling. difficulty in swallowing, stridor, respiratory distress (increased respiratory rate and increased effort)

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14
Q

respiratory system: bronchospasm and increased mucous production

A

wheezes, respiratory distress (increased respiratory rate and increased effort)

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15
Q

cardiovascular system

A

vasodilation
increased vascular permeability
shock

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16
Q

cardiovascular system: vasodilation

A

leading to a form of distributive shock

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17
Q

cardiovascular system: increased vascular permeability

A

leading to intravascular depletion and potentially hypovolemic shock

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18
Q

define shock

A

hypoperfusion, reduced organ perfusion

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19
Q

types of shock

A

cardiogenic
obstructive
hypovolemic
distributive

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20
Q

what is sepsis

A

Sepsis is a serious and potentially life-threatening medical condition that occurs when the body’s response to an infection leads to systemic inflammation, widespread tissue damage, and organ dysfunction

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21
Q

shock on the CNS

A

dizziness, syncope, feeling of impending doom, headache, metallic taste

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22
Q

shock on the Cardiac

A

compensatory tachycardia, acute cardiac failure (acute drop in cardiac output, acute pulmonary edema, acutely raised JVP), ischemic chest pain dysrhythmias

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23
Q

shock on the respiratory system

A

compensatory respiratory distress

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24
Q

shock on the peripherals

A

measured low BP, weak peripheral pulses, warm pink peripherals (in the case of distributive shock)

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25
Q

shock on the gastrointestinal

A

diarrhoea and cramping (through increased smooth muscle contraction)

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26
Q

common allergens

A

food
venoms: bites , stings
medication: esp. muscle relaxants, NSAIDs incl. aspirin, antibiotics (penicillin), antivenom, IV contrast media (used in CT scans)

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27
Q

define a biphasic anaphylaxis

A

there is an initial reaction followed by a delayed. second phase reaction 6-72 hours after the initial reaction without re-exposure to the allergen

28
Q

life time prevalence of anaphylaxis

A

1-2% of the population as a whole

28
Q

epidemiology of anaphylaxis

A

it is increasing, and has been attributed to the increased number of potential allergens to which people are exposed

29
Q

allergens common in children

A

food allergy

30
Q

allergens common in adults

A

radiocontrast media
insect stings
medications

31
Q

if the pulse is absent

A

advanced life support

32
Q

if the pulse is present

A

primary survey
ABCDE approach

33
Q

first step in treating a patient with anaphylaxis

A

position the patient appropriately (in a resus, head down, legs raised)
provide supplemental O2
check glucose
insert IV line
apply monitors

34
Q

Advanced life support treatment

A

SAMPLE history
high quality CPR ongoing
early defibrillation
ACLS medications
reverse reversible causes of anaphylaxis:
-adrenalin
-fluid resus
-promethazine

35
Q

plans for primary survey

A

*adrenalin
*IV fluid bolus
*promethazine (anti- histamine)
*hydrocortisone (steroid)

36
Q

bolus dose meaning

A

A bolus dose is a single, relatively large dose of a medication given at one time. In this context, it suggests the administration of epinephrine as a quick and concentrated injection.

37
Q

when should we repeat adrenalin dose

A

repeat every 10 minutes if persistent upper airway obstruction (UAO)/ bronchospasm. hypotension

38
Q

dose of adrenalin >12 yrs

A

0.5 mg IM

39
Q

dose of adrenalin 6-12 yrs

A

0.3 mg IM

40
Q

dose of adrenalin 2-5 yrs

A

0.2 mg IM

41
Q

when do we administer fluid bolus

A

if SBP<90 mmHg

42
Q

types of fluid bolus

A

normal saline 0.9%
ringers lactate

43
Q

Crystalloid Fluids:

A

Crystalloid fluids are solutions that contain small particles (crystals) dissolved in water. Normal Saline 0.9% and Ringer’s Lactate are examples of crystalloid solutions commonly used for fluid resuscitation

44
Q

adrenaline administration in adults

A

adult: 1-4 IV rapid infusion

45
Q

adrenaline administration in paeds

A

20ml/kg

46
Q

promethazine (antihistamine) usage

A

not essential in acute setting

47
Q

promethazine (antihistamine) >12 yrs

A

25mg IM/IV

48
Q

promethazine (antihistamine) 6-12 yrs

A

12.5 mg IM/IV

49
Q

promethazine (antihistamine) 2-5 yrs

A

6.25 mg IM/IV

50
Q

hydrocortisone (steroid) usage

A

not essential in acute setting

51
Q

hydrocortisone (steroid) >12 yrs

A

200mg IV/IM

52
Q

hydrocortisone (steroid) 6-12 yrs

A

100mg IV.IM

53
Q

hydrocortisone (steroid) 2-5 yrs

A

50 mg IV/IM

54
Q

further persisting UAO (angioedema)

A

*nebulized adrenalin (1mg adrenalin: 3mg N/ saline)
*definitive airway:
-endotracheal intubation
-surgical cricothyroidotomy

55
Q

further persisting bronchospasm

A

as per status asthmaticus:
- beta 2 agonists (salbutamol) inhaled via metered dose inhaler (MDI)/ nebulizer

56
Q

status asthmaticus

A

“Status asthmaticus” refers to a severe and prolonged asthma attack that does not respond adequately to standard treatments like bronchodilators and inhaled corticosteroids

57
Q

beta 2 agonists

A

a class of medications that act on beta-2 adrenergic receptors. These receptors are found primarily in the smooth muscle of the bronchi (airways) in the lungs. Beta2 agonists are commonly used in the management of respiratory conditions, particularly those involving bronchoconstriction (narrowing of the airways).

57
Q

endpoints of resuscitation: airway

A

attained, maintained and protected by the patient or by you

57
Q

endpoints of resuscitation: breathing

A

reduction in respiratory distress and improvement of other clinical features (e.g. wheezes)
SO2> 94%
ETCO2 35- 45 mmHg
PaO2 80-100mmHg

57
Q

endpoints of resuscitation: circulation

A

*improvement of signs and symptoms of hypotension
*SBP>90mmHg
* MAP> 65mmHg
* U- output 0.5-1ml/kg/hr
*Improvement of Lactate

58
Q

how long to we observe an anaphylactic patient

A

> /= 6 hrs

59
Q

when to we refer for admission

A

severe anaphylactic reaction
-severe/ life threatening presentation
-needed fluid bolus
-repeat adrenalin dose required
uncontrolled asthma

60
Q

discharging an anaphylactic patient

A

Bio: prescribe adrenalin auto- injector device
psycho: education
social: educate care givers

61
Q

follow up

A

allergist

62
Q

why we administer adrenaline during anaphylaxis

A

Vasoconstriction and Blood Pressure Elevation:
Adrenaline acts on alpha-adrenergic receptors, leading to vasoconstriction (narrowing of blood vessels). This helps counteract the severe drop in blood pressure (hypotension) that can occur during anaphylaxis. Elevated blood pressure is essential for maintaining blood flow to vital organs.

Bronchodilation:
Adrenaline stimulates beta2-adrenergic receptors in the lungs, resulting in bronchodilation (widening of the airways). This helps alleviate the symptoms of bronchoconstriction, such as wheezing and difficulty breathing, which are common in anaphylaxis.

Reduction of Urticaria and Angioedema:
Adrenaline helps to reduce skin manifestations of anaphylaxis, including urticaria (hives) and angioedema (swelling). This can be crucial in preventing airway obstruction due to swelling.

Stabilization of Mast Cells and Basophils:
Anaphylaxis is characterized by the release of various chemical mediators, such as histamine, from mast cells and basophils. Adrenaline stabilizes these cells, preventing further release of inflammatory substances and mitigating the allergic response.

63
Q
A

Acute Care (15 decks)

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