week 9 anaphylaxis

Question 1

what is the definition of anaphylaxis?

Answer 1

any acute onset illness with typical skin features (urticarial rash, erythema/flushing, angiodema) plus the involvment of respiritoy and or cardiovascular or persistant GI symptoms

or actue onset of hypotenstion/bronchospasm/upper airway obstruction

Question 2

what is an antigen?

Answer 2

substance the induce the formation of antibodeis

Question 3

what are antibodies?

Answer 3

protective protien substances that bind to an antigen to facilitte antigen nuterlisation

Question 4

what are immunolgloblins?

Answer 4

large glycoprotiens that are prodcued by plasma cells that respond to antigenic stimulation

Question 5

what are the two key immunoglobilins in an anaphylactic reation?

Answer 5

IgE and IgG

Question 6

what are mediators?

Answer 6

protiens that caused a number of psyiological responses

remain inactive untill triggered

Question 7

what are the main mediatrs involved in anaphylaxis?

Answer 7

histamine
platlet aggregating factors PAF
Luekotrienes

Question 8

what is an allergic response?

Answer 8

Protective reaction however becomes oversensitive that may be directed to harmless antigens

Question 9

what is an allergen?

Answer 9

any antigen that causes an allergic response

Question 10

what prodcuces a type one allergic reaction?

Answer 10

mediated through IgE where mast cells or basophils are involved - target reactions can have organ involvement causing anaphylactic reaction

Question 11

what is the age group with the highest rates of anapylaxis?

Answer 11

children under 5 years old

Question 12

what is the mortality rate of an anaphylaxis reaction?

Answer 12

3%

Question 13

what are the pathopysiology steps in an anaphylactic reaction?

Answer 13

first exposure to anitgen
stimulates b-lymphocytes produced IgE antibodeis

Second exposure
Ige attached to mast cell and basophil membranes
mast cell destabilisation

Question 14

what are the three main actions of mast cell destailisation in an anaphylactic reaction?

Answer 14

Increased capiliary permiability
vasodilation of capilaires and venules
contractions of non-vascular smooth muscle

Question 15

what other immunological response can lead to anaphylaxis?

Answer 15

IgG antigen coplexes
cause copliment and coagulation system activation leading to the degranulation of mast cells and relases of mast and basophil cells

Question 16

what non-immunological causes can trigger anaphylaxis?

Answer 16

exercise, cold weather, medications and other

Question 17

what does increased capilary membrane lead to?

Answer 17

intravascular fluid leakage leading to odeama, angiodema, larygnal odeama (stridor), bronchial odeama (wheeze) and urticaria (skin)

Question 18

what is urtacaria?

Answer 18

bumps/hive like welts on the skin

Question 19

what does vasodilation of capilaries lead to in anaphylaxs\is?

Answer 19

hypotension, relative hypovolema, decreasde pre-load and SV, decreased CO, decreased tissue perfusion, anaerobic metabolism

Question 20

what does contraction of non-vascular smooth muscles do in anaphylaxis?

Answer 20

bronchospasm, laryngospasm, GIT cramps/discomfort/nausea, vomiting, dioreha

Question 21

what are the sings and symptoms of anaphylaxis and why do they occur?

Answer 21

Dizziness/alterconcious state - decreased perfusion

palpitations- tachycardia - SNS response to vasodilation/inadeqaute perfusion

SOB
Expiritory wheeze
1 - leukotrines are potent bronchoconstrictors
Lower airway bronchospasm and hypersecretion of mucous

Nausea and vomiting

• smooth muscle constriction
• increased mucous production
  shunting of perfusion to other organs
  reddened, inflammed skin

reddened inflammed skin

Question 22

what are the neurological symptoms of an anaphylaxis reaction?

Answer 22

syncope, anxiety, seizure, dizziness, weakness, headache

Question 23

what are the cardiovascular symptoms of anaphylaxis?

Answer 23

odeama, tachycardia, chest tightness, arythmias, hypotension

Question 24

what are the respiritory symptoms in anaphylaxis?

Answer 24

wheezeing, stridor, rhinorrhea, angiodema, larayngal odeam, increased mucous, decreased breth sounds, SOB, bronchospasm

Question 25

what are the GI symptoms of anaphylaxis?

Answer 25

nausea, vommiting, diprreaha, abdo pain

Question 26

what are the integumentary sings of anaphylaxis?

Answer 26

pruritus, erythema, urticaria

Question 27

what is uricaria

Answer 27

due to the realses of histamine, platlete activatinf factors and cytokines - sensory nerves leake blood and fluid into tissue

causing a systemic non-blancing rash

Question 28

what are some of the anaphylaxis mimics?

Answer 28

sevre resp failure/asthma
upper airway obstruction
septic/cardiogenic shock
APO
drug overdose
hypovolemic shock 
croup/epiglotisis

Question 29

what are the most deaths caused by in anapylaxis?

Answer 29

directly realted to upper airway obstruction

Question 30

what does administering adrenalin do for anaphylaxis?

alpha and beta 1 effects

Answer 30

alpha adrenergic 
- increased periperal vascular resistance - Increasde CO and BP 
decreased perihperal vsasodilation
decreased aniodema
decreas urticaria

beta adrenergic
- positve inotrope and chronotrope
increased foce and rate of cardiac contraction

Question 31

what does administering adrenalin do for anaphylaxis?

beta and beta 2 effects

Answer 31

beta 2
bronchodilation

beta adrenergic
increased cAMP production which stabalises mast cells leadinf to decreased inflamatory mediator relases and increases bronchodilation

Question 32

what are some potential compliactions from administering adreanaline? what routes are these most common with?

Answer 32

overtreating 
uncontrolled hypertension
tachycardia/aryth ias
chest pain 
ventricular arythmias 
seizures

IV/IO route

Question 33

what is the action of glucagon when given to paitents with anaphylaxis?

Answer 33

if pt on beta blockers- olols and not responding to adrenaline assits my causinf vasoconstroction and increased myocardial contractiliy

Question 34

what are the pitfalls regarding anaphylaxis treatement

Answer 34

failure to
- recognise subtle early presentation
to recoginde need for acute and definitve airway managment
to administer early adreanline
recognised contraindications for RSI in pt
to anticipate difficulties in the treatment of pt taking beta blockers