A+E

Question 1

What is the pathophysiology of anaphylaxis?

Answer 1

severe type 1 hypersensitivity reaction stimulates mast cells to rapidly release histamine (called mast cell degranulation) - causing rapid onset sx with airway/breathing/circulation compromise (this is what differentiates from allergic reaction)

Question 2

What are typical allergic symptoms?

Answer 2

• urticaria
• itching
• angio-oedema (esp lips/eyes)
• abdo pain

Question 3

What sx indicate anaphylaxis?

Answer 3

• SOB
• wheeze
• laryngeal swelling (causing stridor)
• tachycardia
• lightheadedness
• collapse

Question 4

ABCDE assessment of anaphylaxis

Answer 4

A - secure airway
B - O2 if req, salbutamol can help with wheezing
C - IV bolus fluids (hypotension, tachycardia)
D - lie pt flat for better cerebral perfusion
E - look for flush/hives/angio-oedema

Question 5

What 2 medications are given once anaphylaxis is confirmed?

Answer 5

1. IM adrenalin (repeat after 5 mins if req) !!!! 500mg for adults
2. antihistamines, non-sedating (once stable - oral chlorphenamine or cetirizine)

Question 6

When is anaphylaxis considered refractory?

Answer 6

resp/cardio issues persisting despite 2 doses IM adrenaline