Anaphylaxis and Bites Flashcards
(51 cards)
Define anaphylaxis
- Life threatening systemic hypersensitivity reaction to contact w/ allergen
- May appear w/in minutes of exposure to offending allergen
How does anaphylaxis manifest?
- Respiratory distress
- Pruritis
- Urticaria
- Mucus membrane swelling
- GI disturbances (N/V/D/pain)
- Vascular collapse
What is the pathophys of anaphylaxis?
- Anaphylaxis requires prior sensitization or exposure to a specific antigen
- On re-exposure IgM & IgG Ab recognize the antigen as foreign & bind to it
- Ag presence activates IgE on basophils -> promotes release of mediators
How is histamine involved in anaphylaxis?
- Sudden release of histamine
2, Vasodilation & ↑ capillary permeability - Fluids leak into alveoli
How are Prostaglandins, bradykinin, serotonin
involved in anaphylaxis?
- Spread through body triggering systemic responses
2. Vasodilation, smooth muscle contraction, ↑ mucus production, ↑ capillary permeability
What are the most common allergens that cause anaphylaxis?
- Pollen extracts
- Serum
A. Immunizations - Venom
A. Bee venom - Foods
A. Nuts, berries, seafood - Drugs
A. Antibiotics, ASA - Radiographic contrast dye
What are the respiratory manifestations of anaphylaxis?
- Mucus membrane swelling
- Hoarseness
- Stridor
- Wheezing
What are the cv manifestations of anaphylaxis?
- Tachycardia
2. Hypotension
What are the cutaneous manifestations of anaphylaxis?
- Pruritis
- Urticaria
- Angioedema
How is anaphylaxis diagnosed?
- Anaphylaxis is a clinical diagnosis
A. Signs
B. Symptoms
C. Allergen exposure
How is anaphylaxis treated?
- Remove known Ag
- Epinephrine ASAP
- Beta agonist aerosol
- Oxygen
- Histamine 1 and 2 receptor blockade
- Corticosteroids
How is epi dosed for anaphylaxis?
- 0.3 – 0.5 of 1:1000 SC or IM
- Repeat dose q 5-20 min prn
- Life threatening sx’s
A. 2.5 ml of 1:10,000 solution IV slowly
B. IV NS fluid resuscitation
C. Vasopressor agents (Dopamine)
What beta agonist aerosols are used for anaphylaxis?
Albuterol 1 UD via nebulizer; repeat up to 3 Tx back to back
How is oxygen dosed for anaphylaxis?
Titrate to maintain SaO2 ≥ 95%
What histamine 1 and 2 receptor blockade agents are used for anaphylaxis?
- Diphenhydramine 50-100 mg IM or IV
2. Ranitidine 50 mg IV
How can anaphylaxis be prevented?
- Skin testing
- Avoid offending agent
- Desensitization
- Medic Alert bracelet
- Epi-pen
What is a normal reaction to an insect sting?
Pain, swelling, & redness around the sting site
What is a large local rxn to an insect sting?
Pain, swelling, & redness around the sting site and swelling extending beyond the sting site
What is a toxic rxn to multiple stings?
- Toxic reaction can occur if multiple stings (50+)
A. Hemolysis, rhabdomyolysis, renal failure, DIC, liver dysfunction
What are the sxs of a bee sting allergy?
- Difficulty breathing
- Hives or flushed or pale skin that spreads to areas beyond the sting
- Swelling of the face, throat, or tongue
- Wheezing or difficulty swallowing
- Restlessness & anxiety
- Rapid pulse
- Dizziness or a sharp drop in BP
- Nausea, vomiting or diarrhea
- Loss of consciousness
How is a bee sting (w/o allergy) treated?
- Sac of venom & stinger left inskin
- Remove stinger w/in 30 sec to avoid receiving more venom
- If stung on hand, remove rings immediately
- Wash area w/ soap & water, then apply an antiseptic
- Elevate extremity
- Ice
- Diphenhydramine prn
How is a bee sting allergy treated?
- Epinephrine 0.3 mg (EpiPen) SQ & diphenhydramine PO
A. Usually prevents more severe allergic reaction - Transport to ER
A. Observe for recurrent reaction - If anaphylaxis:
A. Repeat Epinephrine SQ
B. Oxygen
C. IV corticosteroid
D. Albuterol UD via nebulizer, repeat prn - Consider allergy testing & immunotherapy
What is the general information regarding eastern equine encephalitis?
- Virus spread by mosquitoes
- Cases found in MA & NH
- Fatality rate in humans is 33%
- Currently no cure for human infections
- 4& of infected humans develop symptoms
A. 6 cases/yr in the US
B. 1/3 of cases develop permanent brain damage
What are the sxs for EEE?
1. 3-10 day incubation period A. High fever B. Muscle pain C. Altered mental status D. Headache E. Meningeal irritation F. Photophobia G. Seizures