Miscellaneous Flashcards
Biphasic anaphylasis
recurrence of symptoms following apparent resolution of the initial anaphylactic episode when the is no additional exposure to the trigger. Typically occur within 8-10 hours after resolution of the initial symptoms.
Protracted anaphylaxis
anaphylactic reactions that lasts for hours, days or even weeks in extreme cases.
Define anaphylaxis
An acute, severe, life-threatening allergic reaction
Occurs in pre-sensitised person
Release of immune & inflammatory mediators, from
Basophils & mast cells
Classically IgE mediated
Anaphylactoid is a similar clinical picture but different pathophysiology
Rapidly progressive Upper airways obstruction Rash Bronchospasm Hypotension Cardiovascular collapse
Initial evaluation of anaphylaxis
Acute onset of illness (minutes to hours)- ABC
Occurrence of 2 or more following signs or symptoms
Skin, mucosal… hives, pruritus, flushing, swelling
Resp compromise (dyspnoea, wheeze, stridor, hypoxemia, low PEF
Hypotension or end-organ failure
Persistent GI symptoms… crampy abdominal pain, vomiting
Reduced BP after exposure to known allergen
Systolic <90mmHg or >30% decrease from baseline
what do you test before treatment of anaphylaxis
Serum tryptase level
what do you do post anaphylaxis treatment
Consider admission Possible reactivation Refer to immunology Needs to carry adrenaline pen Needs strong education Offer support, training and adrenaline injector to carers allergen avoidance
complication of DIC
Acute renal failure Life threatening haemorrhage Cardiac tamponade Haemothorax Intra-cerebral haematoma Gangrene and loss of digits
DDX of DIC
Severe liver disease
TTP-HUS
Fibrinogenolysis
Heparin induced thrombocytopenia
definition DIC
An acquired syndrome, characterised by…
Activation of coagulation pathways, resulting in…
Formation of intravascular thrombi, resulting in…
Obstruction and ischaemia of end-organs and multi-organ failure
Depletion of platelets
Depletion of coagulation factors
Spontaneous bleeding
If 3 unrelated sites are involved: highly suggestive of DIC
May be… Acute or Chronic
(can also be Overt or Non-Overt… depending on whether the haemostatic system is decompensated or not)
Very high mortality: 40-80%
Features of both thrombosis & haemorrhage
define hyperkalemia
Normal serum levels…. 3.5 - 5.5mmol/L
Always treat if > 7.0mmol/L
However if there is evidence of cardiac conduction abnormality, start treating even if not >7.0mmol/L
Evidence of conduction abnormality: ECG changes, arrhythmia
predisposing Rf for hyperkalemia
Existing kidney disease Adrenal insufficiency Genetic Hyperkalaemic periodic paralysis Renal tubular acidosis
precipitating risk factors for hyperkalemai
Iatrogenic Rhabdomyolysis Crush injury Seizures Tumour lysis syndrome Haemolysis Transfusions Sickle cell ? Could result be an error from RCC lysis
ECG findings for hyperkalemia
Tall Tented T-waves
Prolonged PR interval
Widened QRS complex
Shortened QT interval
Loss of P wave
Sine-wave formation
Other arrhythmia:
Any kind of conduction block… LBBB, RBBB, bifasicular block
Sinus bradycardia
Junctional blocks with ventricular escapes
Terminal events: asystole or Ventricular Fibrillation or PEA
in patients with hyperkalemia receiving salbutamol - who should be careful
Be careful in patients with ischaemic heart disease
Causes tachycardia, tremor
what are iatrogenic source of potassium
potassium supplements, potassium sparing diuretics, ACEi/ARB TPN, some IV drugs NSAID’s Cyclosporin/Tacrolimus Azole antifungals, e.g. Ketoconazole
who needs dialysis in hyperkalemai
Persistent Hyperkalaemia (> 7.0mmol/L)
Fluid overload (e.g. refractory pulmonary oedema)
Pericarditis
Acidosis (arterial pH < 7.2, Bicarbonate < 12mmol/L, base excess < 10)
Symptomatic Uraemia
Symptomatic uremia symptoms
pericarditis encephalopathy coma fits usually urea > 45mmol/L)
what is febrile neutropenia
- Neutrophiles < 1.0X 10*9
2. Fever > 38 degrees celsius
causes of neutropenia
Post Chemotherapy Sepsis Marrow failure Infiltration, toxin, viral, drug Radiation exposure Other Drugs Marrow failure Infiltration, toxin, viral, drug Autoimmune Inherited condition
Acute Febrile non-haemolytic reaction
Defined:
Temp > 38OC (or > 1OC from pre-transfusion value)
AND no other symptom AND onset > 15 minutes into transfusi
Acute urticarial reaction without anaphylaxis
Defined:
Skin reaction ONLY
AND Hives/Rash < 25% body AND no other symptoms
treatment of transfusion ass. cardiac overload
Stop transfusion
Supplemental oxygen
Furosemide
IV 40-80mg
why do you do a cxr in Transfusion reaction investigation
CXR
Fluid overload/pulmonary oedema in TACO
Bilateral patchy infiltrates in TRALI
