Anaphylaxis Flashcards
What are the Clinical features of Anaphylaxis
Clinical features of anaphylaxis are
1) swelling of lips, tongue, epiglottis, and pharynx
2) lower airway bronchospasm
3) pruritic, erythematous rash, urticaria, and angioedema
4) peripheral vasodilation and increased vascular permeability causing plasma leakage leading to hypotension and shock.
Itching, erythema, urticaria, oedema, angioedema,wheeze, airway obstruction/stridor. Cyanosis, Tachycardia, hypotension
What type of hypersensitivity reaction is anaphylaxis
It is IgE-mediated => Hypersensitivity Type 1
Give some common causes of anaphylaxis
Hypersensitivity to
Drugs: e.g. Penicillin, Contrast dye
Latex
Stings, fish, eggs, peanuts
Is gluten an allergen?
It can be as everything can be but if someone ever asks you, its not. Celiac disease is not hypersensitivity to gluten, it is an autoimmune reaction.
You are called to see a 56-year-old man who is one day post appendicectomy because he became acutely short of breath. He has just been given his second dose of antibiotic, the first having been given in theatre. On your arrival, the patient has stridor, with the following observations: heart rate 122/min, blood pressure 86/48 mmHg and saturations 85% in air.
What is the most appropriate immediate action?
Give the patient 0.5mg Adrenaline IM
How much adrenaline is contained in 1 ampoule of adrenaline?
How much would you administer?
1 ampoule = 1mg in 1 ml or 1:1000 => we need half an ampoule
How much adrenaline is in a minijet?
10ml syringes containing 1mg in 10 ml => contains 1mg
You decide to give a patient 0.5 mg of Adrenaline IM. How will you administer this?
A full adrenaline ampoule (1 in 1000)
0.1 ml of an ampoule of adrenaline (1 in 1000)
A full adrenaline minijet (1 in 10,000)
A half of an adrenaline minijet (1 in 10,000)
What is meant by 1 in 1,000/10,000?
A half of an adrenaline minijet (1 in 10,000)
How does the management of a patient with Anaphylaxis change based on the presence of a pulse?
Presence of a pulse = 0.5mg (1:1000) IM Adrenaline
No pulse = 1mg (1:10,000) IV Adrenaline every 3-5 minutes during resus efforts
STATION: Act out your management of this patient properly. It sucks but you learn a lot and recap a lot of missed stuff. (if youre studying for exam just keep same number and move on)
Also Ensure you follow this up later with
IV Hydrocortisone (steroid)
IV Chlorphenamine (Antihistamine)
Extra points
You are called to a ward to review a 32-year-old woman who appears to be suffering from an allergic reaction after receiving piperacillin with tazobactam (Tazocin®) for the treatment of pneumonia.
Her symptoms are limited to pruritis and a macular rash on her trunk.
Which one of the following would be the most appropriate immediate course of action?
SWITCH TO CO-AMOXICLAV
ATTEMPT TO INDUCE EMESIS
ADMINISTER ORAL CHLORPHENAMINE
ADMINISTER IV HYDROCORTISONE
ADMINISTER IM ADRENALINE
To get 5/5 must say: First I will stop administration of Piptaz or causative agent and switch to another non-penicillin antibiotic based on sensitivity analysis or empiric.
Administration of oral chlorphenamine is correct.
A 38-year-old man is seen having a severe itch and hives all over the body within a few minutes after eating food at a restaurant. The paramedics arrive at the scene. His pulse is 102 beats per minute, and his blood pressure is 85/65 mmHg.
What indications in and out of the case would warrant adrenaline administration?
Hypotension
Difficulty breathing (airway obstruction/stridor)
End-organ damage (any thing that you would consider was septic e.g. altered GCS)
What part of the acute management of anaphylaxis algorithm is not essential in the acute improvement of symptoms
Steroids (IV hydrocortisone)
How long do steroids need to have an effect?
What are their role in anaphylaxis?
Inhaled need 5 hours. Injected needs 6-8hrs
Its role is to prevent recurrent attacks (increased risk after the first one)
What would be considered refractory anaphylaxis?
How will you manage?
2x IM 0.5mg adrenaline = refractory anaphylaxis
IV adrenaline 1mg IV adrenaline
