Anaphylaxis

Question 1

ABCDE

Answer 1

Airway, Breathing, Circulation, Disability, Exposure approach.

Question 2

Early treatment with _ is the treatment of choice for patients having an anaphylactic reaction.

Answer 2

intramuscular adrenaline

Question 3

Possible triggers for anaphylactic reaction:

Answer 3

Stings (wasp, bee)
Nuts (peanut, almond)
Food (milk, fish, banana)
Antibiotics (penicillin, cephalosporin)
Anaesthetic drugs (Suxamethonium)
Other drugs
Contrast media (iodinated)
Other (latex, hair dye)

Question 4

Suxamethonium

Answer 4

Short term anaesthetic

Question 5

Cephalosporin

Answer 5

Antibiotic

Question 6

Fatal food reactions cause respiratory arrest typically after_

Answer 6

30–35 minutes;

Question 7

insect stings cause collapse from shock after _

Answer 7

10–15 minutes

Question 8

deaths caused by intravenous medication occur most commonly within_

Answer 8

five minutes

Question 9

Anaphylaxis is likely when all of the following 3 criteria are met:

Answer 9

Sudden onset and rapid progression of symptoms
Life-threatening Airway and/or Breathing and/or Circulation problems
Skin and/or mucosal changes (flushing, urticaria, angioedema)

Question 10

Anaphylaxis Airway problems:

Answer 10

Airway swelling, e.g., throat and tongue swelling (pharyngeal/laryngeal oedema). The patient has difficulty in breathing and swallowing and feels that the throat is closing up.
Hoarse voice.
Stridor – this is a high-pitched inspiratory noise caused by upper airway obstruction

Question 11

Anaphylaxis Breathing problems:

Answer 11

Shortness of breath – increased respiratory rate.
Wheeze.
Patient becoming tired.
Confusion caused by hypoxia.
Cyanosis (appears blue) – this is usually a late sign.
Respiratory arrest.

Question 12

Anaphylaxis Circulation problems:

Answer 12

Signs of shock – pale, clammy.
Increased pulse rate (tachycardia).
Low blood pressure (hypotension) – feeling faint (dizziness), collapse.
Decreased conscious level or loss of consciousness.
Anaphylaxis can cause myocardial ischaemia and electrocardiograph (ECG) changes.
Cardiac arrest.

Question 13

Non life-threatening conditions mistaken for Anaphylaxis (these usually respond to simple measures):

Answer 13

Faint (vasovagal episode).
Panic attack.
Breath-holding episode in child.
Idiopathic (non-allergic) urticaria or angioedema.

Question 14

Patients with Airway and Breathing problems may prefer to sit up_

Answer 14

as this will make breathing easier.

Question 15

Lying flat with or without leg elevation is helpful for patients with_

Answer 15

a low blood pressure (Circulation problem).

Question 16

If the patient feels faint,_ - this can cause cardiac arrest.

Answer 16

do not sit or stand them up

Question 17

Patients who are breathing and unconscious should be placed _

Answer 17

on their side (recovery position).

Question 18

Pregnant patients should lie on_

Answer 18

their left side to prevent caval compression

Question 19

Adrenaline IM dose adults

Answer 19

– adults 0.5 mg IM (= 500 micrograms = 0.5 mL of 1:1000) adrenaline

Question 20

Adrenaline IM dose children

Answer 20

> 12 years: 500 micrograms IM (0.5 mL) i.e. same as adult dose
300 micrograms (0.3 mL) if child is small or prepubertal
6 – 12 years: 300 micrograms IM (0.3 mL)
6 months – 6 years: 150 micrograms IM (0.15 mL)
< 6 months: 150 micrograms IM (0.15 mL)

Question 21

In patients with a spontaneous circulation, intravenous adrenaline _

Answer 21

can cause life-threatening hypertension, tachycardia, arrhythmias, and myocardial ischaemia.

Question 22

Initially, give the highest concentration of oxygen possible using a mask with an oxygen reservoir. Ensure high flow oxygen (usually greater than 10 litres min-1) to _

Answer 22

prevent collapse of the reservoir during inspiration

Question 23

Antihistamines are a second line treatment for an anaphylactic reaction.
_

Answer 23

Inject chlorphenamine slowly intravenously or intramuscularly.

Question 24

The dose of chlorphenamine depends on age:

Answer 24

> 12 years and adults: 10 mg IM or IV slowly
6 – 12 years: 5 mg IM or IV slowly
6 months – 6 years: 2.5 mg IM or IV slowly
<6 months: 250 micrograms/kg IM or IV slowly

Question 25

Undertake the usual investigations appropriate for a medical emergency, e.g., _

Answer 25

lead ECG, chest X-ray, urea and electrolytes, arterial blood gases etc.

Question 26

The specific test to help confirm a diagnosis of an anaphylactic reaction is _

Answer 26

measurement of mast cell tryptase.

Question 27

Tryptase sampling:

Answer 27

Three timed samples:
Initial sample as soon as feasible after resuscitation has started
Second sample at 1-2 hours after the start of symptoms
Third sample either at 24 hours or in convalescence) - this provides baseline tryptase levels

Question 28

A biphasic reaction is a_

Answer 28

two phase anaphylactic event. This means that after anaphylaxis is treated and the symptoms go away, they return without you being re-exposed to the allergen.

Question 29

Standard UK needle gauges and lengths

Answer 29

Brown 26G 10 mm
Orange 25G 16 mm or 25 mm
Blue 23G 25 mm
Green 21G 38 mm

Question 30

Stridor

Answer 30

a high-pitched, wheezing sound caused by disrupted airflow

Question 31

AVPU - assess the alertness

Answer 31

A - Alert
V - Voice
P - Pain
U - Unresponsive