Anaphylaxis and Medical Errors Flashcards Preview

Year 3 - Clinical Communication Skills > Anaphylaxis and Medical Errors > Flashcards

Flashcards in Anaphylaxis and Medical Errors Deck (25)
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1

What is anaphylaxis

- An acute allergic reaction to an antigen (e.g. bee sting) to which the body has become hypersensitive

2

Describe what happens in the first exposure to an allergen

- Allergen
- causes TH1 to be released
- causes TH2 to be release d
- causes interleukins
- produce IL4
- produces B cells
- IgE is produced from B cells

3

describe what happens in the second exposure to an allergen

- IgE antibody is produce
- bridging takes place
- produces basophils and mast cells

4

What happens when basophils and mast cells degranulate

- they vasoactive and lead to mediator and cytokine release
- this causes release of histamine, leukotrienes, PgD2, platelet activating factor, complement system, eosinophils and neutrophil chemotactic factors, nitric oxide and tryptase

5

What does histamine cause to happen

- tachycardia
- headaches
- mucus secretion
- rhinorrhea
- bronchospasm

6

What does nitric oxide cause

- bronchospasm
- vasodilation

7

What does PgD2 do

- bronchospasm
- pain
- oedema
- vasodilation

8

What does the complement system do

- vasodilation
- bronchospasm

9

what does tryptase do

- proteolysis

10

What does platelet activating factor

- oedema
- vasodilation
- bowel contraction
- bronchospasm
- thrombi and microthrombi

11

How do you manage an anaphylactic reaction

- ABCDE
- diagnosis - acute onset of illness, life-threatening airway and breathing or circulation, usually skin changes

Call for help
- lie patient flat
- raise the patients legs

Adrenaline

12

how and how much adrenaline should you give
- adult or child more than 12 years
- child 6-12 years
- child 6 months to 6 years
- child less than 6 months

- Adrenaline (give IM unless experienced with IV adrenaline), IM doses of 1:1000 adrenaline (repeat after 5 minutes if no better)
- Adult = 500 micrograms IM
- Child more than 12 years = 500 micrograms IM
- child 6-12 years - 300 micrograms IM
- child less than 6 yers = 150 micrograms

13

what levels of chlorphenamine should you give
- adult or child more than 12 years
- child 6-12 years
- child 6 months to 6 years
- child less than 6 months

- adult or child more than 12 years = 10mg
- child 6-12 years = 5mg
- child 6 months to 6 years - 2.5mg
- child less than 6 months - 250 micrograms/kg

14

how much hydrocortisone should you give
- adult or child more than 12 years
- child 6-12 years
- child 6 months to 6 years
- child less than 6 months

- adult or child more than 12 years = 200mg
- child 6-12 years = 100mg
- child 6 months to 6 years = 50mg
- child less than 6 months = 25mg

15

what should you do post anaphylaxis

- consider 3 days of anti-histamines and oral steroids
- observe on HDU for at least 6 hours then review by a senior clinical
- report drug reactions to the MHRA

16

what post anaphylaxis investigations should you carry out

- 12 lead ECG
- CXR
- Bloods
- ABG
- urine output
- mast cell tryptase

17

What is the specific test for the diagnosis of anaphylaxis

- mast cell tryptase

18

What is mast cell tyrptase

- major protein component of mast cell secretary granules - increases in anaphylaxis

19

When does mast cell tryptase peak

- peak levels 1-2 hours after event

20

how often should you do mast cell tryptase

- three timed samples ASAP after event, 1-2 hours after the event and 24 hours after the event

21

What is a biphasic reactions

- recurrent epsiode
- 8-12 hours post event
- 5-25% of anaphylactic patients
- difficult to predict

22

What is the management of anaphylaxis

- post discharge follow up
- EPIPEN
- consider steroids/anti-histamines 3 days
- review by senior clinician before discharge
- as for initial reaction with observation >24 hours

23

What patients are still at risk of an anaphylaxis

- Allergen still in system
- severe slow onset idiopathic reactions
- poor access to A+E
- sever asthmatics
- previous biphasic reaction

24

Who should you give adrenaline auto injections to

- patients at increased risk of reaction

25

What happens in the allergy clinic

- RAST testing
- skin allergy testing - different allergens tested on skin and reaction monitored
- education on signs, symptoms and actions to take if reaction occurs