Immunity disorders & infections Flashcards

Question

Type III allergic rxn

Answer 1

Damage secondary to immune complex formation or deposition Glomerulonephritis, vasculitis, arthralgias

Answer 2

T lymphocyte mediated delayed hypersensitivity type

Answer 3

Chemical Mediator with **no antigen-antibody reactio**n mast cells & basophils activate in a *_non-immune reaction_* → anaphylactoid I.e. MR, meperidine, morphine, etc.

Answer 4

manifests as histamine release related to **total dose** of drug administered & **rate of infusion** ex: muscle relaxants, opioids, & protamine

Answer 5

* Corticosteroid * H1 & H2 receptor antagonist I.e. decadron, benadryl, ranitidine

Answer 6

* IgE mediated response * life threatening * Extravasation of up to 50% of intravascular fluid volume into the EC space possible * hypotension 1^stsign * bronchospasm - seen as increased PIP * edema and airway swelling are late signs

Answer 7

* Antimicrobial agents * PCN → 90% of all allergic reactions & 97% of fatal reactions * Anesthetics * All anesthetic agents can cause anaphylactic reactions with the *exception of ketamine & benzos* * Thiopental has a low risk, but a very high mortality if they have an anaphylactic reaction * Radiocontrast dyes * Foods * I.e. peanuts * Insect venoms * Bee allergy

Answer 8

* Muscle relaxants * 50-60% of intra-op anaphylaxis occurances * actually much more likely to be casing than an antibiotic * protamine * seafood & salmon allergy * NPH insulin * Induction agents * Consider ketamine to prevent reaction in high risk patients * Antibiotics (10-15%) * Volatile anesthetics * Opioids * D/t histamine release * Local Anesthetics * esters more likely than amides * Blood → even with crossmatch * 3% of patients * Dextran/Hetastarch * Vascular grafts * DIC more than anaphylaxis * Latex * 15% periop

Answer 9

* Pulmonary embolism * Pneumothorax – high peak inspiratory pressure * AMI * CVA * Hemorrhage * Aspiration * Pulmonary edema * Venous Air embolism * Vasovagal reaction * Medication overdose * Asthma → _{shouldn’t produce immediate cardiovascular collapse} * Arrhythmia → _{one of the first signs from the muscle reactants these patients could become very bradycardic → may have a loss of profusion to the coronaries and look like an MI} * Pericardial tamponade * Postextubation stridor * Sepsis

Answer 10

* Rapid onset CV collapse often 1st sign → myocardial ischemia & dysrhythmias * **Hypotension** → up to 50% of the ICF moves to ECF secondary to capillary permeability changes + leukotrienes are negative inotropes) * this happens within minutes * Suspect anaphylaxis with sudden hypotension, +/- bronchospasm, following IV drug administration * Bradycardia may occur especially with muscle relaxants * Difficult intubation → laryngeal edema (usually this is if it is in the later phase – keep in mind if they have an LMA or are masking you will need to intubate immediately because it will get worse and worse) * ↑ PIP or inability to ventilate → **bronchospasm** * Flushing, urticaria ## Footnote Ketamine → propofol → epi All could work in severe situation

Answer 11

1. β-lactam * Penicillin, Amoxicillin, Ampicillin, Meticillin 2. quinolones * Ciprofloxacin, Levofloxacin, Ofloxacin, Moxifloxacin 3. sulfonamides 4. vancomycin

Answer 12

* Communication (let everyone know → surgeon, additional personnel) * should stop the case immediately until stable again * Stop administration of likely agent(s) * Oxygenation * Elevate legs if possible to promote blood flow to central circulation * Volume infusion → need at least 10-25 ml/kg * Colloids fluids (10 ml/kg) are preferred to crystalloid fluids (colloids may stay in the intravascular space more) * Fluids boluses over 20 minutes

Answer 13

* Epinephrine – (always always start with epi but sometimes it does fail) * _{Blocks inflammatory mediator release from sensitized cells} * _{Restores cell membrane permeability} * _{β-agonist effect = relaxation of bronchial smooth muscle, ↑ BP & ↑ inotropy} * _{β2 → bronchodilation, ↓ histamine release from mast cells; also best to reverse bronchospasm} * _{β1 → will help heart compensate &↑ inotropy} * _{α1 stimulation → vasoconstriction & restore vascular integrity} * Adult IV: 10 mcg-1 mg titrate q 1-2 minutes * _{Start with 10 mcg then double with each repeated dose} * Children: 1-10 mcg/kg titrate q 1-2 minutes

Answer 14

* **Glucagon**: 1-5 mg bolus + infusion 1-2.5 mg/hr * ↑ cAMP promotes inotropic activity and helps with the bronchoconstriction * **Norepinephrine:** 0.05-0.1 mcg/kg/min * will not help the bronchospasm situation – but will help in shunting blood to central areas –emergency drug * **Vasopressin**: 2-10 unit bolus + infusion 0.01-0.1 unit/min infusion * moves blood to central circulation

Answer 15

Not necessarily life saving but will help slow down or stop reaction causing anaphylaxis * β2 agonists * albuterol if patient is still moving air * Histamine antagonism * Diphenhydramine (IV)(0.5-1 mg/kg IV) with Ranitidine 50 mg IV → better for prevention than for tx. * H1 & H2 need to be blocked together - has the best effect * Corticosteroids: * Enhances β-effects of other agents * Inhibits arachidonic acid release (↓ leukotrienes & prostaglandins) * Reduced activation of the complement system * **Hydrocortisone** is favored 250 mg IV (Methylprednisolone also OK 80 mg IV) * Children hydrocortisone 50-100 mg & methylprednisolone 2 mg/kg * Get them on board as soon as possible - wont see immediate effects

Answer 16

Delay case if not an absolute emergency 1. Normal temperature 2. Normal blood glucose 3. MAP \>65 mmHg 4. CVP 8-12 mmHg 5. Urine output adequate 6. Normalized pH * correct metabolic acidosis - Plasmalite or Normasol- better compared to LR and NS because they are right at physiologic pH – it is maintained MUCH easier 7. Mixed venous O₂ Sat \>70% 8. Lower VT 6-8 ml/kg → to prevent barotrauma 9. PIP \< 30 cmH2O 10. Hgb 7-9 g/dL 11. Prevent additional infection

Answer 17

Don't even try **Absolute contraindication** to do an epidural anesthesia * Especially with hemodynamic instability → patient may not tolerate ↓ SVR * Epidural abscess if bacteremic blood introduced into epidural space

Immunity disorders & infections Flashcards

(41 cards)