Anaphylaxis Flashcards
What are the Clinical features of Anaphylaxis
Clinical features of anaphylaxis are
1) swelling of lips, tongue, epiglottis, and pharynx
2) lower airway bronchospasm
3) pruritic, erythematous rash, urticaria, and angioedema
4) peripheral vasodilation and increased vascular permeability causing plasma leakage leading to hypotension and shock.
Itching, erythema, urticaria, oedema, angioedema,wheeze, airway obstruction/stridor. Cyanosis, Tachycardia, hypotension
What type of hypersensitivity reaction is anaphylaxis
It is IgE-mediated => Hypersensitivity Type 1
Give some common causes of anaphylaxis
Hypersensitivity to
Drugs: e.g. Penicillin, Contrast dye
Latex
Stings, fish, eggs, peanuts
Is gluten an allergen?
It can be as everything can be but if someone ever asks you, its not. Celiac disease is not hypersensitivity to gluten, it is an autoimmune reaction.
You are called to see a 56-year-old man who is one day post appendicectomy because he became acutely short of breath. He has just been given his second dose of antibiotic, the first having been given in theatre. On your arrival, the patient has stridor, with the following observations: heart rate 122/min, blood pressure 86/48 mmHg and saturations 85% in air.
What is the most appropriate immediate action?
Give the patient 0.5mg!!!!!(MG) Adrenaline IM
You decide to give a patient 0.5 mg of Adrenaline IM. How will you administer this?
A full adrenaline ampoule (1 in 1000)
0.1 ml of an ampoule of adrenaline (1 in 1000)
A full adrenaline minijet (1 in 10,000)
A half of an adrenaline minijet (1 in 10,000)
What is meant by 1 in 1,000/10,000?
A full Adrenaline minijet of 1 in 10,000
1 in 10,000 means 1 gram per 10,000mls => 0.1mg/ml
1 in 1000 means 1 gram per 1,000mls => 1mg/ml
How does the management of a patient with Anaphylaxis change based on the presence of a pulse?
Presence of a pulse = 0.5mg (1:1000) IM Adrenaline
No pulse = 1mg (1:10,000) IV Adrenaline every 3-5 minutes during resus efforts
STATION: Act out your management of this patient properly. It sucks but you learn a lot and recap a lot of missed stuff. (if youre studying for exam just keep same number and move on)
Also Ensure you follow this up later with
IV Hydrocortisone (steroid)
IV Chlorphenamine (Antihistamine)
Extra points
You are called to a ward to review a 32-year-old woman who appears to be suffering from an allergic reaction after receiving piperacillin with tazobactam (Tazocin®) for the treatment of pneumonia.
Her symptoms are limited to pruritis and a macular rash on her trunk.
Which one of the following would be the most appropriate immediate course of action?
SWITCH TO CO-AMOXICLAV
ATTEMPT TO INDUCE EMESIS
ADMINISTER ORAL CHLORPHENAMINE
ADMINISTER IV HYDROCORTISONE
ADMINISTER IM ADRENALINE
For each, state why yes or no.
To get 5/5 must say: First I will stop administration of Piptaz or causative agent and switch to another non-penicillin antibiotic based on sensitivity analysis or empiric.
Administration of oral chlorphenamine is correct.
Co-amoxiclav contains penicillin; this patient has had an allergic reaction to another penicillin-containing antibiotic
rendering this an unsuitable option.
Inducing emesis would not be effective at relieving symptoms particularly as piperacillin/tazobactam can only be given
intravenously.
Administering an antihistamine will alleviate the pruritis and acute presentation of the mild allergic reaction.
As there is no evidence of anaphylaxis the adrenaline and IV steroids are not indicated.
A 38-year-old man is seen having a severe itch and hives all over the body within a few minutes after eating food at a restaurant. The paramedics arrive at the scene. His pulse is 102 beats per minute, and his blood pressure is 85/65 mmHg.
What indications in and out of the case would warrant adrenaline administration?
Hypotension
Difficulty breathing (airway obstruction/stridor)
End-organ damage (any thing that you would consider was septic e.g. altered GCS)
