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anaphylaxis Flashcards

1
Q

What is anaphylactic shock?

A

A Type I IgE-mediated hypersensitivity reaction causing capillary leak, wheeze, cyanosis, edema (larynx, lids, tongue, lips), and urticaria.

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2
Q

What is an anaphylactoid reaction?

A

A reaction resulting from direct release of mediators from inflammatory cells, usually due to a drug like acetylcysteine, without involving antibodies.

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3
Q

Name a common drug that can precipitate anaphylaxis.

A

Penicillin and contrast media used in radiology.

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4
Q

List a few common allergens causing anaphylaxis.

A

Peanuts, tree nuts, fish, shellfish, eggs, strawberries, and latex.

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5
Q

What are key signs and symptoms of anaphylactic shock?

A

Itching, sweating, diarrhea, vomiting, erythema, urticaria, edema, wheeze, laryngeal obstruction, cyanosis, tachycardia, and hypotension.

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6
Q

What conditions can mimic anaphylaxis?

A

Carcinoid syndrome, pheochromocytoma, systemic mastocytosis, and hereditary angioedema.

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7
Q

What is the first step in managing anaphylaxis?

A

Secure the airway and give 100% oxygen.

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8
Q

When should intubation be considered in anaphylaxis?

A

If there is imminent or severe respiratory obstruction.

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9
Q

What is the initial dose of adrenaline for anaphylaxis?

A

0.5mg (0.5mL of 1:1000 solution) administered intramuscularly.

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10
Q

How often should adrenaline be repeated in anaphylaxis?

A

Every 5 minutes, if needed, based on blood pressure, pulse, and respiratory function.

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11
Q

What is the role of IV fluids in anaphylaxis management?

A

Administer 0.9% saline IV, 500mL over 15 minutes, up to 2L if needed, titrating against blood pressure.

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12
Q

What additional treatments might be needed if wheezing?

A

Treat for asthma and consider ventilatory support.

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13
Q

What should be done if hypotension persists despite treatment?

A

Admit to ICU, consider IV adrenaline, aminophylline, and nebulized salbutamol, and seek expert help.

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14
Q

What is the purpose of measuring serum tryptase after anaphylaxis?

A

To confirm the diagnosis of anaphylaxis, as tryptase levels reflect mast cell activation.

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15
Q

How is adrenaline administered IV in severe cases?

A

Administer 100mcg/min (0.5mL of 1:10,000 solution) IV, titrated with the patient’s response.

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16
Q

What should be done if a patient is on a β-blocker?

A

Consider using IV salbutamol in place of adrenaline due to potential interference with adrenaline’s action.

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17
Q

What is the recommended follow-up after anaphylaxis?

A

Admit to the ward, monitor ECG, continue chlorphenamine for itching, suggest a MedicAlert bracelet, and teach self-injection of adrenaline.

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18
Q

Why use a MedicAlert bracelet for anaphylaxis?

A

It provides emergency responders with crucial information about the individual’s allergies, ensuring prompt and appropriate treatment.

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19
Q

What is the role of skin-prick tests in anaphylaxis?

A

To identify specific IgE-mediated allergens to avoid.

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20
Q

How is self-injected adrenaline used in anaphylaxis prevention?

A

Teach patients to use an autoinjector (e.g., Epipen 0.3mg) to prevent fatal attacks and ensure proper training on its use.

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21
Q

What is the key difference between anaphylaxis and anaphylactoid reactions?

A

Anaphylaxis is IgE-mediated, while anaphylactoid reactions result from direct mediator release without involving antibodies.

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22
Q

Which allergen is particularly common in medical environments?

A

Latex.

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23
Q

What are the immediate steps to take if anaphylaxis is suspected?

A

Secure airway, administer 100% oxygen, and remove the causative agent.

24
Q

What are the typical doses of chlorphenamine and hydrocortisone for anaphylaxis?

A

Chlorphenamine 10mg IV and hydrocortisone 200mg IV.

25
Q

How is blood pressure managed during anaphylaxis treatment?

A

Monitor continuously and titrate IV fluids (e.g., 0.9% saline) against blood pressure.

26
Q

What should be done if a patient with anaphylaxis has persistent wheezing?

A

Treat for asthma and provide additional respiratory support if necessary.

27
Q

How should anaphylaxis be managed if symptoms recur after initial treatment?

A

Continue monitoring and treatment, possibly including additional doses of adrenaline and other supportive measures, and seek expert help.

28
Q

What precaution should be taken for patients with known β-blocker use?

A

Consider using IV salbutamol instead of adrenaline due to potential β-blocker interference.

29
Q

What is the role of hydrocortisone in the management of anaphylaxis?

A

It helps reduce inflammation and prevent delayed reactions, though it does not provide immediate relief.

30
Q

Why is serum tryptase measured post-anaphylaxis?

A

To confirm anaphylaxis by indicating mast cell activation.

31
Q

What should be included in patient education for anaphylaxis?

A

Training on self-injection of adrenaline, avoidance of known allergens, and wearing a MedicAlert bracelet.

32
Q

How can skin-prick tests be useful for anaphylaxis patients?

A

They help identify specific allergens to avoid by detecting IgE-mediated hypersensitivity.

33
Q

What are the signs of severe respiratory obstruction in anaphylaxis?

A

Stridor, hoarseness, difficulty swallowing, and cyanosis.

34
Q

What should be done if anaphylaxis symptoms improve but hypotension persists?

A

Admit to ICU, consider IV adrenaline, and use other supportive measures like aminophylline and nebulized salbutamol.

35
Q

How is IV adrenaline administered in a critical situation?

A

Administer at 100mcg/min (0.5mL of 1:10,000 solution) IV, titrated to response, and stop once a response is observed.

36
Q

When should intubation be considered in the management of anaphylaxis?

A

If there is severe respiratory obstruction or failure to maintain airway patency.

37
Q

What role does adrenaline play in anaphylaxis?

A

Adrenaline counteracts the effects of histamine by acting as a vasoconstrictor and bronchodilator, stabilizing the patient’s condition.

38
Q

What is the importance of rapid adrenaline administration in anaphylaxis?

A

Rapid administration is crucial to prevent progression to severe symptoms and improve patient outcomes.

39
Q

How often should the use of self-injected adrenaline be reviewed with patients?

A

Regularly, to ensure proper technique and understanding of when to use it.

40
Q

What are the typical skin findings in anaphylaxis?

A

Urticaria (hives) and angioedema (swelling of deeper layers of skin).

41
Q

How does anaphylaxis affect the cardiovascular system?

A

Causes tachycardia (increased heart rate) and hypotension (low blood pressure) due to vasodilation and capillary leak.

42
Q

What immediate action should be taken if a patient is on a β-blocker and experiences anaphylaxis?

A

Consider using IV salbutamol as β-blockers can reduce the efficacy of adrenaline.

43
Q

What should be done if a patient with anaphylaxis is not improving with adrenaline?

A

Continue adrenaline administration, provide supportive care, and consider additional medications like aminophylline or nebulized salbutamol.

44
Q

What fluid resuscitation is typically used in anaphylaxis?

A

0.9% saline IV, starting with 500mL over 15 minutes and potentially increasing to up to 2L, based on the patient’s blood pressure and clinical status.

45
Q

Why is continuous ECG monitoring important during anaphylaxis management?

A

To detect and manage potential arrhythmias and assess the heart’s response to treatment.

46
Q

How can anaphylaxis lead to respiratory failure?

A

Through bronchospasm, laryngeal edema, and compromised airway patency, which can impede oxygenation and ventilation.

47
Q

What is a common sign of impending respiratory failure in anaphylaxis?

A

Severe stridor or inability to speak due to laryngeal edema.

48
Q

What are the long-term preventive measures after anaphylaxis?

A

Avoidance of known allergens, carrying an adrenaline autoinjector, and having a clear action plan for future allergic reactions.

49
Q

What additional support might be needed for a patient with persistent hypotension after anaphylaxis?

A

Possible admission to ICU for intensive monitoring and treatment, including potential use of IV adrenaline, aminophylline, and nebulized salbutamol.

50
Q

How often should serum tryptase be measured after anaphylaxis?

A

1–6 hours post-reaction to help confirm the diagnosis.

51
Q

What is the importance of raising the patient’s feet during anaphylaxis management?

A

It may help improve venous return and restore circulation in the context of hypotension.

52
Q

What role does adrenaline play in managing anaphylaxis?

A

Acts as a vasoconstrictor to counteract hypotension, a bronchodilator to relieve wheezing, and a stabilizer of mast cell activation to mitigate the allergic reaction.

53
Q

How should patients with a history of severe anaphylaxis be educated about future management?

A

They should be taught to use self-injected adrenaline, recognize early symptoms of anaphylaxis, and seek immediate medical attention.

54
Q

When is it appropriate to use IV adrenaline instead of IM adrenaline?

A

When the patient is in severe shock or has no detectable pulse, requiring immediate, titratable response.

55
Q

What should be considered if symptoms of anaphylaxis recur?

A

Continuous monitoring for potential biphasic reactions and reassessment of the treatment plan, including possible additional doses of adrenaline.

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