Fluids And Anaphylaxis Flashcards
Which ions are most important in strong ion theory
Sodium
Types of shock
Cardiogenic
Hypovolaemic
Obstructive
Distributive - septic anaphylactic neurogenic
Anaphylaxis signs and symptoms
Angioedema
Rash
Hives
Flushing
Tongue and oral swelling
Circulatory collapse
Coronary spasm
Wheeze
Stridor
Abdo pain
Diarrhoea
Anaphylaxis tx
ABCDE
adrenaline
High flow 02
Fluid challenge
Steroids - hydrocortisone
Antihistamines - chlorphenamine
How does adrenaline help anaphylaxis
Stops further MAST cell degranulation
What additional treatment should be considered in anaphylaxis if the ot is taking beta blockers
Glucagon
What concentration adrenaline is given in anaphylaxis
1:1000
IM adrenaline doses for anaphylaxis
12yrs + - 500 micrograms (0.5ml)
6-12 yrs - 300 micrograms (0.3ml)
<6yrs - 150 micrograms (0.3 ml)
<6mo - 100-150 micrograms (0.1-0.15ml)
IV adrenaline dose for anaphylaxis
Adult - 50microgram
Children 1microgram/kg
Why should IV colloid fluids be stopped in anaphylaxis
Potential trigger of anaphylaxis
Which steroid and antihistamine are given in anaphylaxis
Hydrocortisone IM or slow IV
Chloramphenamine IM or slow IV
Chloramphenamine doses in anaphylaxis
12yrs + - 10mg
6-12yrs - 5mg
6mo-6yrs - 2.5mg
<6mo - 250micrograms/kg
Hydrocortisone doses in anaphylaxis
12yrs+ - 200mg
6-12yrs - 100mg
6mo-6yrs - 50mg
<6mo - 25mg
3 categories of fluids
Crystalloid
Colloid
Natural
When can saline be harmful as a fluid
When given long term
Which fluid is acid base balanced
Plasmalyte
Why are gelatin fluids rarely used
Reports of anaphylaxis
No long term benefits
Why are starch fluids no longer given
Long term renal legacy
What are PFCs
Perflurocarbon based oxygen carriers
Trials straying soon
Disadvantages of whole blood
Hard to get, store, and crossmatch
Disadvantages of packed red cells compared to whole blood
2,3 DPG degrades over time decreasing O2 capacity
no clotting factors
How does mannitol work
Large sugar mols increase oncotic pressure -> draws fluid from interstitial space into vasculature
Does mannitol have short or long term effects
Short
How does hypertonic saline work
Salt increases osmotic pressure -> draws fluid from interstitial space to vasculature
Which fluids are used for neurosurgical rescue
Mannitol
Hypertonic saline
What complication is reduced by using albumin fluid in ITU
Oedema
What component in Hartman’s is broken into bicarbonate
Lactate
Why does alcohol effect fluid balance
Inhibits ADH production
Why is hartmans not used 1st line in A&E
Can worsen hyperkalaemia or other electrolyte imbalances
How do gelatina boost circulation
Gelatin forms chunks of protein -> incr oncotic pressure
How quickly are gelatina broken down
~1hr
Anaphylactic reaction pathophysiology
Allergen triggers production of IgE by B cells -> IgE binds to surface of mast cell or basophil -> subsequent exposure to antigen -> antigen bridges gap between 2 antibody molecules -> degranukation of cell and release of histamine + other mediators
Effect of histamine on capillaries
Increases permeability and distension of capillaries
Which anaphylaxis treatment has long term effects not short term
Steroids
How often should IM adrenaline be repeated in anaphylaxis
Every 5 mins
Refractory anaphylaxis
No improvement in breathing or circulation problems after 2 doses of IM adrenaline
IV fluid challenge in anaphylaxis
Adults - 500-1000ml
Children - 10ml/kg
Crystalloid fluid
Anaphylaxis life threatening problems
Hoarse voice, stridor
Incr WOB, wheeze, fatigue, cyanosis, SpO2 <94
Low BP, signs of shock, decr consciousness
Where should IM adrenaline be injected
Anterolateral aspect of middle third of thigh
