Ch.21allegryanaphylaxis Flashcards
The study of the body’s immune system
Immunology
The___ protects the human body from foreign substances and organisms. Without the___ for protection, life as you know it would not exist. You would be under constant attack from multiple types of invaders, such as bacteria or viruses, that wanted to make your body a home. Fortunately, most people have__ that are well equipped to detect unauthorized visits or invading attacks by foreign substances. Once a foreign substance invades the body, the body goes on alert and initiates a series of responses to inactivate the invader.
immune system
Pathophysiology
There are many conditions related to the immune system, but an allergic reaction is the only immunologic emergency you will treat as an EMT. Contrary to what many people think, an allergic reaction, an exaggerated immune response to any substance, is not caused directly by an outside stimulus, such as a bite or sting or ingestion of food or medicine. Rather, it is a reaction by the body’s immune system, which releases chemicals to combat the stimulus. Among these chemicals are___, both of which contribute to an allergic reaction.
histamines and leukotrienes
The body’s exaggerated immune response to an internal or surface agent
Allergic reaction
The body’s response to a substance perceived by the body as foreign
Immune response
Chemical substances released by the immune system in allergic reactions that are responsible for many of the symptoms of anaphylaxis, such as vasodilation
Histamines
Chemical substances that contribute to anaphylaxis; released by the immune system in allergic reactions
Leukotrienes
___is an extreme allergic reaction that is life threatening and involves multiple organ systems. In severe cases,___ can rapidly result in shock and death. Two of the most common signs of anaphylaxis are widespread urticaria, or hives, small areas of generalized itching or burning that appear as multiple small, raised areas on the skin (FIGURE 21-2), and angioedema, areas of localized swelling (FIGURE 21-3). Another often-observed sign is wheezing, a high-pitched, whistling breath sound that is typically heard on expiration, usually resulting from bronchospasm/bronchoconstriction and increased mucus production. Signs of possible upper airway narrowing include voice changes and stridor, a high-pitched respiratory sound that is usually heard during inspiration. You may also note hypotension due to vasodilation, as well as increased capillary permeability (causing fluid from the bloodstream to seep into the tissues). One symptom that is often overlooked in patients experiencing an allergic reaction is persistent gastrointestinal dysfunction (eg, nausea, vomiting, and abdominal cramps). Patients can also become confused.
Anaphylaxis
Small areas of generalized itching and/or burning that appear as multiple raised areas on the skin; hives
Urticaria
Localized are not as of swelling beneath the skin, often around the eyes and lips, but can also involve other body areas as well
Angioedema
Certain_, such as shellfish and peanuts, may be the most common trigger of anaphylaxis. These__ account for 30% of deaths from anaphylaxis, most commonly in adolescents and young adults. Symptoms of a food allergy may take more than 30 minutes to appear and may not include the presence of skin signs, such as hives.
Abdominal cramping, vomiting, and diarrhea are common, and the reaction can be quite severe and involve the respiratory and/or cardiovascular systems. It is possible for a patient to be unaware of the exposure; for example, a person who is allergic to peanuts may eat something without knowing that one of the ingredients is peanuts.
Food
The second most common source of anaphylactic reactions is___, particularly antibiotics (eg, penicillin) and nonsteroidal anti-inflammatory drugs (NSAIDs). If the___ is injected, the reaction may be immediate (within 30 minutes) and severe (FIGURE 21-4). Reactions to oral___ may take more than 30 minutes to appear, but can also be very severe.
medication
People who inhale dust, pollen, mold, mildew, or other organic materials to which they are sensitive may experience an allergic reaction. Some common___ allergens include ragweed, ryegrass, maple, and oak.
Plants
Certain__, makeup, soap, hair dye, latex, and various other substances can cause severe allergic reactions. Latex is of particular concern to health care providers; patients can be sensitive to it, but so can you! Up to 10% of health care providers will become sensitized to latex. For some, simply being in the same room as someone wearing powdered latex gloves can cause a reaction. As a result, almost all EMS agencies use latex alternatives such as nitrile gloves. Follow your local protocol.
chemicals
When an insect bites or stings, the act of injecting its venom is called envenomation.
Envenomation by a honeybee, wasp, ant, yellow jacket, or hornet may cause a localized reaction, causing swelling and itching at the site, or a severe and systemic reaction (ie, anaphylaxis).
Insect bites and stings
The most common allergens fall into one of the following five general categories
Food
Medication
Plants
Chemicals
Insect bites and stings
The act of injecting venom
Envenomation
Signs and symptoms of insect stings and bites include sudden pain, swelling, localized heat, widespread urticaria, and redness in light-skinned people, usually at the site of injury. There may be itching and sometimes a__, which is a raised, swollen, well-defined area on the skin (FIGURE 21-7). The swelling associated with an insect bite may be dramatic and sometimes frightening to the patient or to you. However, as long as these manifestations remain localized, they are not usually serious.
wheal
In more severe (anaphylactic) cases, patients may experience stridor, bronchospasm and wheezing, chest tightness and coughing, dyspnea, anxiety, gastrointestinal complaints, and hypotension. Occasionally, respiratory failure and confusion occur. If untreated, an anaphylactic reaction can proceed rapidly to death. In fact, more than two-thirds of patients who die of anaphylaxis do so within the first___, so rapid treatment and transport is essential.
30 minutes
The body normally produces___ (TABLE 21-2).___ is a sympathomimetic hormone. This means it mimics the sympathetic (fight or flight) response.___ has various properties that cause the blood vessels to constrict, which reverses vasodilation and hypotension; this, in turn, elevates the diastolic pressure and improves coronary blood flow. Other properties of___ increase cardiac contractility and relieve bronchospasm in the lungs. Because___ has immediate action, it can rapidly reverse the effects of anaphylaxis.___ is prescribed by a physician and comes predosed in an____ auto-injector (EpiPen). In addition to the EpiPen, you may also encounter an Auvi-Q, another type of___ injection, in the home. They are shaped differently than an EpiPen and come in a third dose of 0.1 mg for those patients weighing 17 to 33 lb (7.5 to 15 kg).
epinephrine
Epi doses
Adults 0.3mg (EpiPen)
Children 0.15mg (EpiPen)
A medication that increases heart rate and
blood pressure but also eases breathing problems by decreasing muscle tone of the bronchiole tree; a substance produced by the body (commonly called adrenaline), and a drug produced by pharmaceutical companies that increases pulse rate and blood pressure; the drug of choice for an anaphylactic the reaction
Epinephrine
An adult EpiPen can be used for a patient weighing over __
66 ib (30 kg)
