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IHO Block 3 > SIM Case > Flashcards

SIM Case Flashcards

1
Q

What are common allergens associated with type I hypersensitivity?

A
  • Proteins (Foreign serum, vaccines)
  • Plant pollens (rye grass, ragweed, timothy grass, birch trees)
  • Drugs (Penicillin, Sulfonamides, Local anesthetics, Salicylates)
  • Foods (Nuts, Seafood, Eggs, Peas, beans, Milk)
  • Insect products (Bee venom, Wasp venom, Ant venom, Cockroach calyx, dust mites)
  • Mold spores
  • Animal hair and dander
  • Latex
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2
Q

What mediates type I hypersensitivity?

A

IgE!

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3
Q

What mediates type II hypersensitivity?

A

IgG or IgM mediated cytotoxic hypersensitivity

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4
Q

What mediates type III hypersensitivity?

A

Immune Complex-Mediated Hypersensitivity

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5
Q

What mediates type IV hypersensitivity?

A

Cell-mediated hypersensitivity

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6
Q

How does a type I hypersensitivity work?

A

Antigen induces cross-linking of IgE bound to mast cells and basophils with release of vasoactive mediators.

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7
Q

How does type II hypersensitivity work?

A

Antibodies directed against cell surface antigens mediate cell destruction via complement activation or ADCC (antibody dependent cell mediated cytotoxicity)

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8
Q

How does type III hypersensitivity work?

A

Ag-Ab complexes deposited in various tissues induce complement activation and an ensuing inflammatory response mediated by massive infiltration of neutrophils

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9
Q

How does Type IV hypersensitivity work?

A

Sensitized Th1 cells release cytokines that activate macrophages or Tc cells that mediate direct cellular damage. Th2 cells and CTLs mediate similar responses.

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10
Q

What are examples of Type I hypersensitivity?

A

Systemic anaphylaxis, localized anaphylaxis such as hay fever, asthma, hives, food allergies, and eczema.

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11
Q

What are examples of Type II hypersensitivity?

A

Blood transfusion reactions, erythroblastosis fettles and autoimmune hemolytic anemia.

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12
Q

What are examples of Type III hypersensitivity?

A

Localized Arthus reaction and generalized reactions such as serum sickness, necrotizing vasculitis, glomerulonephritis, rheumatoid arthritis, and systemic lupus erythrematosus

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13
Q

What are examples of Type IV hypersensitivity?

A

Contact dermatitis, tubercular lesions, and graft rejection. (PPD TB test)

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14
Q

What must occur prior to an anaphylactic event?

A

Sensitization to an allergen!

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15
Q

What are the target tissues affected in a type I hypersensitivity response?

A

Smooth muscle. small blood vessels, mucous gland, blood platelets, sensory nerve endings, eosinphils

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16
Q

What does small blood vessel vasodilation from anaphylaxis do to the body?

A

Small blood vessel vasodilation leads to a drop in blood pressure and compensatory increased heart rate.

17
Q

What other cells act in anaphylaxis (other than mast cells)?

A

Macrophages, platelet activating factor (released by macrophage).
Histamine and platelet activation factor act on smooth muscle vascular endothelium, causing anaphylaxis.

18
Q

What is Stridor type breathing?

A

In a child, when they are undergoing an allergic reaction.

The rib cage will retract, you’ll see a cave in the center of their belly and tracheal tugging.

19
Q

How do you stabilize during an emergency situation?

A
  1. Airway
  2. Breathing
  3. Circulation
  4. Rapid Treatment
20
Q

How do you treat someone undergoing anaphylactic shock?

A
  1. Epinephrine 0.01 mg/kg IM (0.01 mg/kg of 1:1000 epinephrine)
    (In our case of a 10 kg infant the dose of epinephrine would be 0.10 ml.)
  2. Supplemental oxygen
  3. IV fluids to support intravascular volume
  4. Continuous monitoring/admission
  5. Consider antihistamine, like Benadryl
  6. Consider albuterol nebulizer for airways
  7. Wearable Allergy identification
21
Q

What do you have to check with epinephrine?

A

CONCENTRATION! Make sure it’s 1:1000 concentration

22
Q

What does 1:1,000 and 1:10,000 epinephrine mean?

A

1: 10,000 - 1 mg in 10 mL of volume
1: 1,000 - 1 mg in 1 mL of volume

23
Q

What is the adult dose of epinephrine?

A
  • May use the 0.01 mg/kg dosing to a maximum single dose of 0.5 mg
  • Adult EpiPen is 0.3 mg epinephrine
24
Q

What do corticosteroids do?

A

Help suppress biphasic/rebound reaction

25
Q

Why do you give IV fluids?

A

It’s critical for patients whose hypotension doesn’t respond to epinephrine

26
Q

How should to place patient to avoid vascular collapse?

A

Feet up!

27
Q

What does epinephrine do?

A

-Activates the alpha1 adrenergic receptor and beta1 and beta2 adrenergic receptors, leading to immediate vasoconstriction, increased peripheral resistance, decreased mucosal edema, increased cardiac inotropy/chronotropy, and bronchodilation, reversing the airway obstruction and vascular collapse.

28
Q

What are common adverse effects to epinephrine?

A

Dizziness, anxiety, agitation, tremulousness, headache, pallor and palpitations.

29
Q

What is the onset of action for epi?

A

3-5 minutes

30
Q

What is the correct dose for a patient over and under 66 lbs?

A

Over - 0.3 mg

Under - 0.15 mg

31
Q

What if wheezing and coughing don’t respond well to epinephrine?

A

Patients may benefit from receiving beta2 agonist nebulizers.

IHO Block 3 (13 decks)

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