anaphylaxis

Question 1

What is anaphylactic shock?

Answer 1

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

Question 2

What is an anaphylactoid reaction?

Answer 2

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

Question 3

Name a common drug that can precipitate anaphylaxis.

Answer 3

Penicillin and contrast media used in radiology.

Question 4

List a few common allergens causing anaphylaxis.

Answer 4

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

Question 5

What are key signs and symptoms of anaphylactic shock?

Answer 5

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

Question 6

What conditions can mimic anaphylaxis?

Answer 6

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

Question 7

What is the first step in managing anaphylaxis?

Answer 7

Secure the airway and give 100% oxygen.

Question 8

When should intubation be considered in anaphylaxis?

Answer 8

If there is imminent or severe respiratory obstruction.

Question 9

What is the initial dose of adrenaline for anaphylaxis?

Answer 9

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

Question 10

How often should adrenaline be repeated in anaphylaxis?

Answer 10

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

Question 11

What is the role of IV fluids in anaphylaxis management?

Answer 11

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

Question 12

What additional treatments might be needed if wheezing?

Answer 12

Treat for asthma and consider ventilatory support.

Question 13

What should be done if hypotension persists despite treatment?

Answer 13

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

Question 14

What is the purpose of measuring serum tryptase after anaphylaxis?

Answer 14

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

Question 15

How is adrenaline administered IV in severe cases?

Answer 15

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

Question 16

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

Answer 16

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

Question 17

What is the recommended follow-up after anaphylaxis?

Answer 17

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

Question 18

Why use a MedicAlert bracelet for anaphylaxis?

Answer 18

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

Question 19

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

Answer 19

To identify specific IgE-mediated allergens to avoid.

Question 20

How is self-injected adrenaline used in anaphylaxis prevention?

Answer 20

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

Question 21

What is the key difference between anaphylaxis and anaphylactoid reactions?

Answer 21

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

Question 22

Which allergen is particularly common in medical environments?

Answer 22

Latex.

Question 23

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

Answer 23

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

Question 24

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

Answer 24

Chlorphenamine 10mg IV and hydrocortisone 200mg IV.

Question 25

How is blood pressure managed during anaphylaxis treatment?

Answer 25

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

Question 26

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

Answer 26

Treat for asthma and provide additional respiratory support if necessary.

Question 27

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

Answer 27

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

Question 28

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

Answer 28

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

Question 29

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

Answer 29

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

Question 30

Why is serum tryptase measured post-anaphylaxis?

Answer 30

To confirm anaphylaxis by indicating mast cell activation.

Question 31

What should be included in patient education for anaphylaxis?

Answer 31

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

Question 32

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

Answer 32

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

Question 33

What are the signs of severe respiratory obstruction in anaphylaxis?

Answer 33

Stridor, hoarseness, difficulty swallowing, and cyanosis.

Question 34

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

Answer 34

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

Question 35

How is IV adrenaline administered in a critical situation?

Answer 35

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

Question 36

When should intubation be considered in the management of anaphylaxis?

Answer 36

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

Question 37

What role does adrenaline play in anaphylaxis?

Answer 37

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

Question 38

What is the importance of rapid adrenaline administration in anaphylaxis?

Answer 38

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

Question 39

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

Answer 39

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

Question 40

What are the typical skin findings in anaphylaxis?

Answer 40

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

Question 41

How does anaphylaxis affect the cardiovascular system?

Answer 41

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

Question 42

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

Answer 42

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

Question 43

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

Answer 43

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

Question 44

What fluid resuscitation is typically used in anaphylaxis?

Answer 44

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.

Question 45

Why is continuous ECG monitoring important during anaphylaxis management?

Answer 45

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

Question 46

How can anaphylaxis lead to respiratory failure?

Answer 46

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

Question 47

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

Answer 47

Severe stridor or inability to speak due to laryngeal edema.

Question 48

What are the long-term preventive measures after anaphylaxis?

Answer 48

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

Question 49

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

Answer 49

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

Question 50

How often should serum tryptase be measured after anaphylaxis?

Answer 50

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

Question 51

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

Answer 51

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

Question 52

What role does adrenaline play in managing anaphylaxis?

Answer 52

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

Question 53

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

Answer 53

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

Question 54

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

Answer 54

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

Question 55

What should be considered if symptoms of anaphylaxis recur?

Answer 55

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