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September OSCE Study > Anaphylaxis (Paed) > Flashcards

Anaphylaxis (Paed) Flashcards

1
Q

What age does the paediatric anaphylaxis guideline refer to?

A

< 12 years old

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2
Q

What is anaphylaxis?

A
  • A severe, potentially life threatening systemic hypersensitivity reaction
  • has a rapid onset usually within 30 minutes but may be up to 4 hours
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3
Q

what are the respiratory symptoms of anaphylaxis? and why are they caused?

A
  • respiratory distress
  • shortness of breath
  • wheeze
  • cough
  • stridor
  • they are caused due to inflammatory bronchoconstriction or upper airway oedema
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4
Q

what are some abdominal symptoms and why are they caused?

A
  • abdo pain/cramping
  • nausea, vomiting and diarrhoea
    • can be caused by insect bites and systemically administered allergens e.g. IV meds
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5
Q

What are some integumentary symptoms and why are they caused?

A
  • hives, welts, itching, flushing, angioedema (e.g. lips and tongue)
    • caused due to vasodilation and vascular hyper permeability
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6
Q

What are some cardiovascular symptoms and why are they caused?

A
  • Hypotension
  • caused due to vasodilation and vascular hyper permeability
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7
Q

what are some common allergens for anaphylaxis?

A
  • insect stings: bees, wasps, jumping jack ants
  • food: peanuts/treenuts, egg, fish/shellfish, dairy products, soy, sesame seeds, wheat
  • Medications: antibiotics, anaesthetic drugs, contrast media
  • Exercise induced: typically affecting young adults (rare)
  • Idiopathic anaphylaxis: No external trigger (rare)
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8
Q

why do anaphylaxis and asthma occur together?

A
  • asthma, food allergy and high risk of asthma frequently occur together, often in adolescence
  • bronchospasm is a common presenting symptom in this group, raising the likelihood of mistaking anaphylaxis for asthma
  • a history of asthma increases the risk of fatal anaphylaxis
    • you must maintain a high suspicion for anaphylaxis in patients with a history of asthma or food allergy
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9
Q

what are other causes of angioedema?

A
  • hereditary angioedema (HAE) and its more broad categorisation: bradykinin-mediated angioedema
  • these may present with similar symptoms to anaphylaxis including abdominal signs and symptoms and laryngeal swelling however will not respond to anaphylaxis management
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10
Q

What do you do if that patient has HAE or bradykinin-mediated angioedema?

A

Follow the patients treatment plan and use their medication

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11
Q

What is Food Protein Induced Enterocolitis (FPIES)?

A
  • a non-immunoglobulin E mediated paediatric allergy that usually presents with nausea and vomiting, and in severe cases may present with collapse, confusion or altered consciousness.
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12
Q

Should FPIES patients be treated with adrenalin?

A

No

  • if the patient has a positive diagnosis of FPIES and a care plan, treat symptomatically (e.g. ondansetron, IV fluid) and transport to hospital
  • consider consultation with receiving hospital for steroid administration
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13
Q

what are the risk factors for refractory anaphylaxis or deterioration?

A
  • expected clinical course (e.g. hx of refractory anaphylaxis/ICU admission/multiple adrenaline doses)
  • Hypotensive
  • Medication as precipitating cause
  • Respiratory symptoms/distress
  • history of asthma of multiple co-morbidities/medications
    • No response to initial dose of IM adrenlaine
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14
Q

Where is the preferred administration site for adrenaline?

A
  • anterolateral mid-thigh
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15
Q

do you Bring the patients adrenaline auto-injector with you to hospital?

A

yes

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16
Q

what do you do if you are waiting for MICA or waiting whilst the adrenaline infusion is being prepared?

A

Continue with IM adrenaline until arrival of MICA or whilst the infusion is being prepared

17
Q

what is adrenaline toxicity? and what should you do if it is identified?

A
  • it can be characterised by nausea, vomiting, shaking, tachycardia or arrhythmia but has some improvement in symptoms and a normal or elevated BP
  • consider whether further noses are appropriate
18
Q

What is the correct dose for children <10kg = 1 year old.

A

A minimum IM dose of 100mcg (0.1ml) is recommended to avoid order-of-magnitude errors if using the 1:1000 ampoule

19
Q

when can you administer additional therapies for anaphylaxis?

A
  • can be administered concurrently or in order of clinical need but must not delay continues adrenaline administration
20
Q

what are some additional therapies for bronchospasm?

A
  • where bronchospasm persists despite the administration of adrenaline, administer salbutamol, ipratropium bromide and dexamethasone.
    • these medications should never be the first line of treatment for bronchospasm associated with anaphylaxis
21
Q

what are some additional therapies for hypotension?

A
  • where hypotension persists despite initial Adrenaline therapy, large volumes of fluid may be extravasating.
    • IV fluid therapy is indicated to support vasopressor administration
22
Q

What do you do if the anaphylactic patient has a management plan?

A

Where possible, paramedics should consider the action plan and align the care in accordance to the specialist recommendation

23
Q

How long does an anaphylactic patient have to be monitored in hospital and why?

A
  • minimum 4 hours
  • in case of biphasic reaction, where symptoms return after an initial resolution
  • this occurs in approximately 20% of cases
24
Q

how do you set up an adrenaline infusion?

A
  • via a syringe pump
  • dilute adrenaline 300mcg to 50ml with 5% dextrose or normal saline (in a 50ml syringe)
  • 1ml = 6mcg
  • 1ml/hr = 0.1mcg/min
25
Q

Recite the CPG for Paediatric Anaphylaxis.

A
26
Q

Recite the additional therapies CPG for Paediatric Anaphylaxis.

A
26
Q

Recite the additional therapies CPG for Paediatric Anaphylaxis.

A
27
Q

What is a the pathophysiology of anaphylaxis?

A
  • Anaphylaxis is a severe systemic hypersensitivity reaction that is rapid in onset; characterised by life threatening airway, breathing and/or circulatory problems; and usually associated with skin and mucosal changes
  • it is an acute, potentially fatal, multi organ system reaction caused bye the release of chemical mediators from mast cells and basophils

September OSCE Study (15 decks)

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