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Gen Med: Emergency Med > Anaphylaxis and Bites > Flashcards

Anaphylaxis and Bites Flashcards

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1
Q

Define anaphylaxis

A
  1. Life threatening systemic hypersensitivity reaction to contact w/ allergen
  2. May appear w/in minutes of exposure to offending allergen
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2
Q

How does anaphylaxis manifest?

A
  1. Respiratory distress
  2. Pruritis
  3. Urticaria
  4. Mucus membrane swelling
  5. GI disturbances (N/V/D/pain)
  6. Vascular collapse
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3
Q

What is the pathophys of anaphylaxis?

A
  1. Anaphylaxis requires prior sensitization or exposure to a specific antigen
  2. On re-exposure IgM & IgG Ab recognize the antigen as foreign & bind to it
  3. Ag presence activates IgE on basophils -> promotes release of mediators
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4
Q

How is histamine involved in anaphylaxis?

A
  1. Sudden release of histamine
    2, Vasodilation & ↑ capillary permeability
  2. Fluids leak into alveoli
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5
Q

How are Prostaglandins, bradykinin, serotonin

involved in anaphylaxis?

A
  1. Spread through body triggering systemic responses

2. Vasodilation, smooth muscle contraction, ↑ mucus production, ↑ capillary permeability

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6
Q

What are the most common allergens that cause anaphylaxis?

A
  1. Pollen extracts
  2. Serum
    A. Immunizations
  3. Venom
    A. Bee venom
  4. Foods
    A. Nuts, berries, seafood
  5. Drugs
    A. Antibiotics, ASA
  6. Radiographic contrast dye
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7
Q

What are the respiratory manifestations of anaphylaxis?

A
  1. Mucus membrane swelling
  2. Hoarseness
  3. Stridor
  4. Wheezing
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8
Q

What are the cv manifestations of anaphylaxis?

A
  1. Tachycardia

2. Hypotension

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9
Q

What are the cutaneous manifestations of anaphylaxis?

A
  1. Pruritis
  2. Urticaria
  3. Angioedema
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10
Q

How is anaphylaxis diagnosed?

A
  1. Anaphylaxis is a clinical diagnosis
    A. Signs
    B. Symptoms
    C. Allergen exposure
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11
Q

How is anaphylaxis treated?

A
  1. Remove known Ag
  2. Epinephrine ASAP
  3. Beta agonist aerosol
  4. Oxygen
  5. Histamine 1 and 2 receptor blockade
  6. Corticosteroids
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12
Q

How is epi dosed for anaphylaxis?

A
  1. 0.3 – 0.5 of 1:1000 SC or IM
  2. Repeat dose q 5-20 min prn
  3. Life threatening sx’s
    A. 2.5 ml of 1:10,000 solution IV slowly
    B. IV NS fluid resuscitation
    C. Vasopressor agents (Dopamine)
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13
Q

What beta agonist aerosols are used for anaphylaxis?

A

Albuterol 1 UD via nebulizer; repeat up to 3 Tx back to back

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14
Q

How is oxygen dosed for anaphylaxis?

A

Titrate to maintain SaO2 ≥ 95%

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15
Q

What histamine 1 and 2 receptor blockade agents are used for anaphylaxis?

A
  1. Diphenhydramine 50-100 mg IM or IV

2. Ranitidine 50 mg IV

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16
Q

How can anaphylaxis be prevented?

A
  1. Skin testing
  2. Avoid offending agent
  3. Desensitization
  4. Medic Alert bracelet
  5. Epi-pen
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17
Q

What is a normal reaction to an insect sting?

A

Pain, swelling, & redness around the sting site

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18
Q

What is a large local rxn to an insect sting?

A

Pain, swelling, & redness around the sting site and swelling extending beyond the sting site

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19
Q

What is a toxic rxn to multiple stings?

A
  1. Toxic reaction can occur if multiple stings (50+)

A. Hemolysis, rhabdomyolysis, renal failure, DIC, liver dysfunction

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20
Q

What are the sxs of a bee sting allergy?

A
  1. Difficulty breathing
  2. Hives or flushed or pale skin that spreads to areas beyond the sting
  3. Swelling of the face, throat, or tongue
  4. Wheezing or difficulty swallowing
  5. Restlessness & anxiety
  6. Rapid pulse
  7. Dizziness or a sharp drop in BP
  8. Nausea, vomiting or diarrhea
  9. Loss of consciousness
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21
Q

How is a bee sting (w/o allergy) treated?

A
  1. Sac of venom & stinger left inskin
  2. Remove stinger w/in 30 sec to avoid receiving more venom
  3. If stung on hand, remove rings immediately
  4. Wash area w/ soap & water, then apply an antiseptic
  5. Elevate extremity
  6. Ice
  7. Diphenhydramine prn
22
Q

How is a bee sting allergy treated?

A
  1. Epinephrine 0.3 mg (EpiPen) SQ & diphenhydramine PO
    A. Usually prevents more severe allergic reaction
  2. Transport to ER
    A. Observe for recurrent reaction
  3. If anaphylaxis:
    A. Repeat Epinephrine SQ
    B. Oxygen
    C. IV corticosteroid
    D. Albuterol UD via nebulizer, repeat prn
  4. Consider allergy testing & immunotherapy
23
Q

What is the general information regarding eastern equine encephalitis?

A
  1. Virus spread by mosquitoes
  2. Cases found in MA & NH
  3. Fatality rate in humans is 33%
  4. Currently no cure for human infections
  5. 4& of infected humans develop symptoms
    A. 6 cases/yr in the US
    B. 1/3 of cases develop permanent brain damage
24
Q

What are the sxs for EEE?

A 
1. 3-10 day incubation period
A. High fever
B. Muscle pain
C. Altered mental status 
D. Headache
E. Meningeal irritation 
F. Photophobia
G. Seizures
25
Q

How is EEE treated?

A
  1. Corticosteroids
  2. Anticonvulsants
  3. Supportive measures
    A. IV fluids
    B. Intubation
    C. Antipyretics
26
Q

What is the habitat of the brown recluse spider?

A
  1. Most common in central US
    A. Missouri, Kansas, Arkansas, Louisiana, eastern Texas, & Oklahoma
  2. Lives in dark, sheltered areas
    A. Under porches, basements, closets, woodpiles
27
Q

What is the timeline for pain and rxn after a brown recluse bite?

A
  1. Pain develops 1-4 hr after bite, & may ↑ in severity
  2. Bite progresses from pustule → bull’s eye lesion → ulcer
    A. Erythematous indurated localized swelling w/ necrotic central area
28
Q

What are the effects of a brown recluse spider bite?

A
  1. Venom is cytotoxic

A. Causes local tissue destruction & hemolysis

29
Q

What are the common sxs 1-4 days after a brown recluse spider bite?

A
  1. Reddish or purplish color around bite (Bull’s eye)
  2. Necrotic ulcer
  3. Fever
  4. Lymphadenopathy
30
Q

What are the systemic sxs 24-48 hrs after a brown recluse spider bite?

A
  1. Arthralgias
  2. Malaise
  3. Fever
  4. Rash
  5. Nausea
31
Q

What are the rare sxs after a brown recluse spider bite?

A
  1. Coma
  2. Blood in urine
  3. Jaundice
  4. Kidney failure
  5. Seizures
32
Q

How is a brown recluse spider bite treated?

A 
1. ER
A. Elisa assay if spider not ID’d
2. Clean with soap & water 
3. Bacitracin/Neosporin
4. Immobilize affected limb
5. Rx meds prn x 1 week
A. Analgesic (Codeine or Tramadol) 
B. NSAID 
C. Muscle relaxer
D. Antihistamine prn
E. +/- Prophylactic Abx
F. Dapsone (diaminodiphenyl sulfone)
6. Ice/Elevation
7. Tetanus if > 10 yr
8. May require debridement 
A. Wet to dry dressings or grafting
33
Q

What is the prognosis for a brown recluse spider bite?

A
  1. Deaths from brown recluse spider bites are more common in children
  2. With proper Tx, survival past 48 hrs has good prognosis
  3. Ulcer may take up to 6 weeks to heal
34
Q

Where are black widow spiders most common?

A
  1. Common in CA

2. Neurotoxic venom

35
Q

What are the early (10-60mins) sxs of a black widow spider bite?

A 
A. Severe pain at site
B. Core muscle spasms
C. Diffuse paresthesias
D. Muscle fasciculations
E. Piloerection
F. Diaphoresis
36
Q

When do sxs peak after a black widow spider bite and what are they?

A 
1. Sx’s peak at 2-3 hr & last up to 7 days
A. Headache
B. N/V
C. Ptosis
D. Hyperactive DTR’s
E. Severe pain
F. Rigid abdominal muscles
G. Severe HTN
H. Tachycardia
I. Death rare, but occurs infants and elderly w/ CVD
37
Q

What is the tx for a black widow spider bite?

A
  1. ER observation x 12-24 hr
  2. Narcotic analgesics
  3. Calcium gluconate for pain
  4. Loose compression dressing
  5. Immobilization
  6. Ice if needed
  7. IV Antivenom in seriously ill infants & elderly
  8. Must test for horse serum sensitivity 1st
  9. High risk for allergic reaction/anaphylaxis
38
Q

When should a pt bitten by a black widow spider be admitted to the hospital?

A
  1. Admit if:
    A. 65yr
    B. Hx of HTN
    C. Severe sx’s
39
Q

What are the common pathogens in a cat bite?

A
  1. Pasteurella multocida

2. Staph aureus

40
Q

How is a cat bite treated?

A
  1. Wound care
  2. Amoxicillin/clavulanate
    (cefuroxime, doxycyline or fluoroquinolone if PCN allergic)
  3. Rabies IgG / vaccine if stray cat
  4. Tetanus if > 10 yr
41
Q

What are the common aerobes in dog bites?

A
  1. Pasteurella multocida
  2. Pasteurella canis
  3. Staph aureus
  4. Streptococcus
  5. Capnocytophaga canimorsus (Gm neg. rod) oral flora
42
Q

What are the common anaerobes in dog bites?

A
  1. Porphyromonas
  2. Bacteroides
  3. Fusobacterium
43
Q

How are dog bites treated?

A
  1. Amoxicillin/clavulanate
  2. 3rd gen. cephalosporin
    A. Cefdinir
    B. Cefotaxime
    C. Ceftriaxone
  3. Fluoroquinolone or doxycycline if PCN allergy
  4. Tetanus if > 10 yr
  5. Loose or no closure
  6. X-ray to R/O Fx
  7. NSAID, ice for crush injury
  8. Elevate extremity
  9. 10 day observation of dog for rabies
    A. Rabies IgG / vaccine if indicated
44
Q

What percentage of snake bites are venomous?

A

25%

45
Q

What are the 2 venomous types of snakes in the US?

A
  1. Veripidae
    A. Hemotoxic (cytolytic) venom
    B. Shreds RBC’s & vessels/severe pain
    C. Rattlesnake, water moccasin, copperhead
  2. Elapidae
    A. Neurotoxic venom
    B. Paralyze respiratory system
    C. Coral snake
46
Q

What are the local sxs of a bite from a viperidae snake?

A
  1. Edema
  2. Wound necrosis
  3. Hemorrhage
47
Q

What are the systemic sxs of a bite from a viperidae snake?

A
  1. Hemolysis
  2. Thrombocytopenia
  3. Coagulopathy
  4. Vomiting
48
Q

What is the treatment of a bite from a viperidae snake?

A
  1. ABC’s
  2. Immobilize limb
  3. ICU observation x 8+ hr
  4. Antivenom
    A. IV CroFab
  5. +/- Abx
49
Q

What are the sxs of a bite from an elapid snake?

A
  1. Paresthesias
  2. Blurred vision
  3. Dysphagia
  4. Hypersalivation
  5. Ptosis
  6. Respiratory depression
50
Q

What are the treatment options of a bite from an elapid snake?

A
  1. ABC’s
  2. Immobilize limb
  3. ICU observation x 8+ hr
  4. IV Antivenom
  5. +/- Abx
51
Q

How are human bites treated?

A

Augmentin
Tetanus if > 10 yr
Loose or no closure
X-ray to R/O Fx

Gen Med: Emergency Med (13 decks)

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