Medical

Question 1

Define anaphylaxis. What are R.A.S.H symptoms of anaphylaxis? What is single-system anaphylaxis?

Answer 1

• Anaphylaxis is the most severe form of an immediate hypersensitivity reaction and encompasses both IgE-mediated reactions and anaphylactoid reactions; the latter do not require previous sensitizing exposures.
• R.A.S.H. symptoms include
  
  • Respiratory distress (dyspnea, wheeze, cough, stridor)
  • Abdominal symptoms (nausea, vomiting, diarrhea, abdominal pain/cramps)
  • Skin/mucosal symptoms (hives, welts, itch, flushing, angioedema, swollen lips/tongue)
  • Hypotension (or hypoperfusion or altered conscious state)
• Anaphylaxis generally involves 2+ systems (2 or more of R.A.S.H.)
• Single-system anaphylaxis may present as isolates HYOPTENSION with Hx of exposure to a known allergen

Question 2

Describe ALL medications used in ACP management of adult anaphylaxis (not including drugs for PSA, induction, etc.). Include doses and considerations for administration

Answer 2

• IM Epinephrine (0.5mg q.5 minutes x 3)
  
  • First line, give prior to IV epi EVERY TIMe)
• IV fluids (500mg aliquots, re-assess lungs q. 250mL)
  
  • Target MAP of 65mm Hg
• IV/IO Epinpehrine (50-100mcg pushes PRN)
  
  • after giving IM epinephrine
  • for pre-arrest patients
• Salbutamol (400mcg MDI PRN or 5mg nebulized PRN)
  
  • AFTER apinephrine for persistent bronchospasm
• Diphenhydramine (50mg IV/IO)
  
  • third-line Tx to target medium-term effects and mitigate histamine release
• Glucagon (no dosage listed, call clinicall)
  
  • For Tx-refractory anaphylaxis in setting of ACE-inhibitor or beta-blocker use

Question 3

How does management of pediatric anaphylaxis differ from adult anaphylaxis?

Answer 3

• IM Epinephrine dosage is 0.01mg/kg (MAX = 0.5mg)
• IV Epinephrine dosage is 5mcg/kg
• Ventolin dosing is much more complicated!
  
  • Nebulized
    
    • 2.5mg if <1yr
    • 5mg if >1yr
  • MDI
    
    • <10kg: not indicated
    • 10-20kg: 500mcg
    • >20kg: 1000mcg!!!!
• Diphenhydramine dosing is 1mg/kg to a max of 50mg IV/IO
• The role of glucagon is uncertain

Question 4

Summarize the following toxidromes:

• Anticholinergic (gravol, atropine)
• CCB
• B-Blocker
• TCA
  *