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E1 E2 Paramedic Science > Anaphylaxis > Flashcards

Anaphylaxis Flashcards

1
Q

What is anaphylaxis?

A

A life-threatening systemic hypersensitivity reaction that causes vasodilation, bronchoconstriction and angioedema as a result of sudden and excessive release of the chemical mediators such as histamine.

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2
Q

What does the systemic hypersensitivity reaction cause?

A

Vasodilation, bronchoconstriction and angioedema

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3
Q

What causes the vasodilation, bronchoconstriction and angioedema?

A

Sudden and excessive release of histamine

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4
Q

What phases occur during anaphylaxis?

A

Sensitisation phase and secondary response phase

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5
Q

Explain the sensitisation phase:

A
  • Antigen (allergen) invade the body via injection, inhalation, ingestion or absorption.
  • Common allergens include food, insect bites/stings and medications
  • Plasma cells synthesize and release large amounts of immunoglobin E (IgE) antibodies
  • IgE antibodies attach to MAST cells and circulating Basophils
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6
Q

Explain the secondary response phase:

A
  • On re-exposure, antigen combine with IgE on MAST cells and basophils, triggering a release of histamine, prostaglandin and leukotrienes.
  • These mediators rapidly induce bronchoconstriction, hyper secretion of mucus and vasodilation causing oedema.
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7
Q

AIRWAY signs and symptoms of anaphylaxis

A
  • Throat/tongue swelling
  • Difficulty breathing and swallowing
  • Hoarse voice
  • Stridor
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8
Q

BREATHING signs and symptoms of anaphylaxis

A
  • Bronchospasm
  • Tachypnoea/dyspnoea
  • Wheeze
  • Fatigue
  • Confusion due to hypoxia
  • Cyanosis
  • Sats <92%
  • Respiratory arrest (last sign)
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9
Q

CIRCULATION signs and symptoms of anaphylaxis

A
  • Hypotension
  • Tachycardia
  • Pale and clammy skin
  • Dizziness
  • Decreased conscious level
  • Myocardial infarction
  • Bradycardia (late sign)
  • Cardiac arrest (late sign)
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10
Q

OTHER signs and symptoms of anaphylaxis

A
  • Skin/mucosal changes (Urticaria/flushing)
  • Diarrhoea and/or vomiting
  • Abdominal pain
  • Anxiety
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11
Q

Anaphylaxis risk factors

A
  • Family history
  • Previous anaphylaxis
  • Asthma
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12
Q

Differential diagnosis to consider for anaphylaxis?

A
  • Asthma
  • Anxiety attack
  • MI
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13
Q

ASSESSMENT - Anaphylaxis

A

DRA(c)BCDE

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14
Q

Danger? Mechanism of Injury? Catastrophic Bleeding?

A
  • Assess for any potential dangers
  • Remove any potential triggers
  • Manage any bleeds
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15
Q

Response

A

AVPU - assess

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16
Q

Airway

A
  • Clear?
  • Any swelling?
  • Correct if compromised
17
Q

C-Spine

A

Is this a concern based on MOI?

18
Q

Breathing

A
  • Rate and depth of respiration?
  • Wheeze?
  • Stridor?
  • Assist with ventilation if required
19
Q

Circulation

A
  • Heart rate?
  • Palpable radial pulse?
  • Oxygen Saturations?
  • Blood pressure - Hypotension?
  • Capillary refill?
  • Skin colour - flushed?
  • Corrected if necessary
20
Q

Disability

A
  • Temperature
  • Blood glucose?
  • PEARL
  • Equal and bilateral air entry
  • 12 lead ECG
  • Alerted GCS
21
Q

Examine

A
  • Oedema?
  • Signs of trigger?
  • Flushed skin?
  • Hives
22
Q

Past Medical History

A
  • Has this happened before?
  • Are they allergic to anything?
  • Have they taken an EpiPen?
23
Q

Treatment:

A

Treat as per JRCALC

- Correct any ABC problems immediately

24
Q

Severe Anaphylaxis Treatment

A
  • Administer oxygen if saturations are below 94%
  • Administer adrenaline IM (1:1000- 500 mcg – no max)
  • Consider fluids if patient is hypotensive (systolic below 90)
  • Consider chlorphenamine (antihistamine) (4mg in 1 tablet- max 4mg)
  • Consider administering hydrocortisone (suppresses inflammation) (200mg injected over 2 mins – max 200mg)
  • Consider nebulised salbutamol for bronchospasm (5mg – 6/8 litres per minute – no max)

Pre-alert and convey to A&E with continuous monitoring, treatment and reassessment.

25
Q

Mild/Moderate Allergic Reaction Treatment

A

Mild/ moderate allergic reaction
If onset is minutes to hours and cutaneous findings of urticaria and or angio-oedema
- Consider chlorphenamine
Refer to GP if stable or convey to A&E for further treatment and management

26
Q

What is the IM adrenaline dosage for severe anaphylaxis?

A

1:1000- 500 mcg – no max

27
Q

What dosage would you consider for chlorphenamine (antihistamine) for severe anaphylaxis?

A

4mg in 1 tablet- max 4mg

28
Q

What dosage would you consider for hydrocortisone?

A

200mg injected over 2 mins – max 200mg

29
Q

What dosage would you use when considering nebulised salbutamol for bronchospasm for severe anaphylaxis?

A

5mg – 6/8 litres per minute – no max

E1 E2 Paramedic Science (8 decks)

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