Fluids And Anaphylaxis

Question 1

Which ions are most important in strong ion theory

Answer 1

Sodium

Question 2

Types of shock

Answer 2

Cardiogenic
Hypovolaemic
Obstructive
Distributive - septic anaphylactic neurogenic

Question 3

Anaphylaxis signs and symptoms

Answer 3

Angioedema
Rash
Hives
Flushing
Tongue and oral swelling
Circulatory collapse
Coronary spasm
Wheeze
Stridor
Abdo pain
Diarrhoea

Question 4

Anaphylaxis tx

Answer 4

ABCDE
adrenaline
High flow 02
Fluid challenge
Steroids - hydrocortisone
Antihistamines - chlorphenamine

Question 5

How does adrenaline help anaphylaxis

Answer 5

Stops further MAST cell degranulation

Question 6

What additional treatment should be considered in anaphylaxis if the ot is taking beta blockers

Answer 6

Glucagon

Question 7

What concentration adrenaline is given in anaphylaxis

Answer 7

1:1000

Question 8

IM adrenaline doses for anaphylaxis

Answer 8

12yrs + - 500 micrograms (0.5ml)
6-12 yrs - 300 micrograms (0.3ml)
<6yrs - 150 micrograms (0.3 ml)
<6mo - 100-150 micrograms (0.1-0.15ml)

Question 9

IV adrenaline dose for anaphylaxis

Answer 9

Adult - 50microgram
Children 1microgram/kg

Question 10

Why should IV colloid fluids be stopped in anaphylaxis

Answer 10

Potential trigger of anaphylaxis

Question 11

Which steroid and antihistamine are given in anaphylaxis

Answer 11

Hydrocortisone IM or slow IV
Chloramphenamine IM or slow IV

Question 12

Chloramphenamine doses in anaphylaxis

Answer 12

12yrs + - 10mg
6-12yrs - 5mg
6mo-6yrs - 2.5mg
<6mo - 250micrograms/kg

Question 13

Hydrocortisone doses in anaphylaxis

Answer 13

12yrs+ - 200mg
6-12yrs - 100mg
6mo-6yrs - 50mg
<6mo - 25mg

Question 14

3 categories of fluids

Answer 14

Crystalloid
Colloid
Natural

Question 15

When can saline be harmful as a fluid

Answer 15

When given long term

Question 16

Which fluid is acid base balanced

Answer 16

Plasmalyte

Question 17

Why are gelatin fluids rarely used

Answer 17

Reports of anaphylaxis
No long term benefits

Question 18

Why are starch fluids no longer given

Answer 18

Long term renal legacy

Question 19

What are PFCs

Answer 19

Perflurocarbon based oxygen carriers
Trials straying soon

Question 20

Disadvantages of whole blood

Answer 20

Hard to get, store, and crossmatch

Question 21

Disadvantages of packed red cells compared to whole blood

Answer 21

2,3 DPG degrades over time decreasing O2 capacity
no clotting factors

Question 22

How does mannitol work

Answer 22

Large sugar mols increase oncotic pressure -> draws fluid from interstitial space into vasculature

Question 23

Does mannitol have short or long term effects

Answer 23

Short

Question 24

How does hypertonic saline work

Answer 24

Salt increases osmotic pressure -> draws fluid from interstitial space to vasculature

Question 25

Which fluids are used for neurosurgical rescue

Answer 25

Mannitol Hypertonic saline

Question 26

What complication is reduced by using albumin fluid in ITU

Answer 26

Oedema

Question 27

What component in Hartman’s is broken into bicarbonate

Answer 27

Lactate

Question 28

Why does alcohol effect fluid balance

Answer 28

Inhibits ADH production

Question 29

Why is hartmans not used 1st line in A&E

Answer 29

Can worsen hyperkalaemia or other electrolyte imbalances

Question 30

How do gelatina boost circulation

Answer 30

Gelatin forms chunks of protein -> incr oncotic pressure

Question 31

How quickly are gelatina broken down

Answer 31

~1hr

Question 32

Anaphylactic reaction pathophysiology

Answer 32

Allergen triggers production of IgE by B cells -> IgE binds to surface of mast cell or basophil -> subsequent exposure to antigen -> antigen bridges gap between 2 antibody molecules -> degranukation of cell and release of histamine + other mediators

Question 33

Effect of histamine on capillaries

Answer 33

Increases permeability and distension of capillaries

Question 34

Which anaphylaxis treatment has long term effects not short term

Answer 34

Steroids

Question 35

How often should IM adrenaline be repeated in anaphylaxis

Answer 35

Every 5 mins

Question 36

Refractory anaphylaxis

Answer 36

No improvement in breathing or circulation problems after 2 doses of IM adrenaline

Question 37

IV fluid challenge in anaphylaxis

Answer 37

Adults - 500-1000ml Children - 10ml/kg Crystalloid fluid

Question 38

Anaphylaxis life threatening problems

Answer 38

Hoarse voice, stridor Incr WOB, wheeze, fatigue, cyanosis, SpO2 <94 Low BP, signs of shock, decr consciousness

Question 39

Where should IM adrenaline be injected

Answer 39

Anterolateral aspect of middle third of thigh