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Emergency Medicine > Anaphylaxis > Flashcards

Anaphylaxis Flashcards

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1
Q

What is anaphylaxis?

A

A type I, IgE mediated life-threatening hypersensitivity reaction

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2
Q

What is the pathophysiology of anaphylaxis?

A

Release of histamine and other agents by mast cells and basophils due to IgE mediated reaction involving a specific antigen -> capillary leak and swelling

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3
Q

What allegens can cause anaphylaxis?

A
  • Drugs - penicillin, contrast media, antisera
  • Latex
  • Stings - wasps, bees, hornets
  • Eggs
  • Fish
  • Peanuts
  • Strawberries, Citrus fruits
  • Semen
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4
Q

What are symptoms of anaphylaxis?

A
  • Itching
  • Sweating
  • Diarrhoea
  • Vomiting
  • Urticaria/Erythema
  • Swelling
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5
Q

What are signs of anaphylaxis?

A
  • Oedema
  • Erythema/Urticaria
  • Wheeze
  • Laryngeal obstruction
  • Cyanosis
  • Tachycardia
  • Hypotension
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6
Q

How would you approach intially managing someone with suspected anaphlaxis?

A

ABCDE

  • A - Secure airway
  • B - Attach 15L/min O2, Give adrenaline IM (0.5mg), Consider salbutamol neb
  • C - IV access, Fluids, Hydrocortisone (200mg), Chlorphenamine (10mg)

Admit for observation

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7
Q

What flow rate would you set oxygen at when treating someone with anaphylaxis?

A

15L/min

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8
Q

What dose of adrenaline woul dyou give someone who was experiencing anaphylaxis?

A

0.5mg (0.5ml of 1:1000)

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9
Q

How would you administer adrenaline in anaphylaxis?

A

Intramuscular injection

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10
Q

What IV access would you want to establish in someone experiencing anaphylaxis?

A

2 large-bore IV cannulae

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11
Q

How often would you repeat adrenaline injections in someone with anaphylaxis?

A

Every 5 mins, as guided by BP, HR, RR etc.

STOP AS SOON AS RESULT OBTAINED

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12
Q

What dose of hydrocortisone would you administer in someone with anaphylaxis?

A

200 mg

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13
Q

How would you administer hydrocortisone?

A

IV

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14
Q

What dose of chlorphenamine would you administer in someone with anaphylaxis?

A

10 mg

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15
Q

How would you administer chlorphenamine?

A

IV

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16
Q

What dose of nebulised salbutamol would you consider giving somoene with anaphylaxis?

A

5mg

17
Q

What volume of saline woul dyou consider giving someone in anaphylactic shock?

A

500 ml over 15 mins initially, but may need 1L if hypotensive

18
Q

What is the general approach to fluid administration in someone in anaphylactic shock?

A

Give as fast as needed and titrate to BP - may need up to 4-8L

19
Q

Once initially managed, what short term management measures would you take to manage someone with anaphylaxis?

A
  • Admit for obervation
  • Continue prednisolone 30-40 mg for 3-5 days
  • Continue chlorphenamine 4mg/6h PO - if itching
  • Monitor ECG
  • Further fluids
  • Consider serum tryptase (1-6h after suspected anaphylaxis)
20
Q

What would you consider as part of longer term management in someone with anaphylaxis?

A
  • Medic alert bracelet
  • Educate on self injection
  • Refer to allergy clinic +/- skin prick testing to identify allergens
  • Clinical incident form if allergic to antibiotic
21
Q

In terms of short term management, what dose and rate of chlorphenamine would you continue somoene on until itching subsided?

A

4mg/6h

22
Q

How long would you continue someone on prednisolone as part of short term management of anaphylactic shock?

A

3-5 days

23
Q

What dose of prednisolone woul dyou consider giving somoene as part of short term management of anaphylaxis?

A

30-40mg

24
Q

What disease processes can mimic anaphylaxis?

A
  • Carcinoid
  • Phaeochromocytoma
  • Systemic mastocytosis
  • Hereditary angioedema
25
Q

What would you do immediately once you recognised someone was having an anaphylactic reaciton?

A

Call 2222

Emergency Medicine (32 decks)

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