Emergency

Question 1

What type of hypersensitivity reaction is anaphylaxis?

Answer 1

Severe type 1 hypersensitivity reaction - IgE stimulates mast cells to rapidly release histamine and other pro-inflammatory chemicals. This is called mast cell degranulation.

Question 2

What should be blood test should be measured within 6 hours of an anaphylactic reaciton as past of the follow up?

Answer 2

Serum mast cell tryptase - remain elevated for up to 12 hours following an acute episode of anaphylaxis so help to establish if a true anaphylaxis has occured.

Question 3

What are the 3 most important drugs to administer during an anaphylactic episode?

Answer 3

Adrenaline
Hydrocortisone
Chlorphenamine

Question 4

What are the adult doses of each of the 3 drugs to be administered in anaphylaxis?

Answer 4

Adrenaline 500mcg (=0.5ml of 1:1000) IM
Chlorphenamine 10 mg IM or IV slowly
Hydrocortisone 200 mg IM or IV slowly.

Question 5

What is the correct dose of adrenaline to give in anaphylaxis for a child aged 6-12 years?

Answer 5

300 micrograms IM (0.3 mL of 1:1000)

Question 6

What is the correct dose of adrenaline to give in anaphylaxis for a child aged under 6 years?

Answer 6

150 micrograms IM (0.15 mL of 1:1000)

Question 7

Clinically, what indicates that a patient is in septic shock?

Answer 7

A vasopressor requirement to maintain a mean arterial pressure (MAP) of 65 mm Hg or greater
and
serum lactate level greater than 2 mmol/L in the absence of hypovolaemia

Question 8

What is the most common cause of cardiogenic shock?

Answer 8

Acute MI

Question 9

What can be used to differentiate between ARDS from acute heart failure if there is doubt?

Answer 9

Pulmonary capillary wedge pressure - using a pulmonary catheter. If this is < 19mmHg => likely ARDS