Chapter 23 anaphylaxis

allergic reaction

• The immune system naturally responds to foreign substances in body to get rid of them, allergic reaction is exaggerated immune response.

anaphylaxis

•  is a severe life threatening allergic reaction that triggers blood vessels to dilate rapidly and cells to leak, causing hypotension and swelling that can obstruct the airway.

  • Blood vessels dilate rapidly causing hypotension

  • Cells leak fluid into the interstitial space

  • tissues swell, including airways

  • If person has respiratory or cardiac or shock symptoms or 2+ body systems involved, it is anaphylaxis

what can be allergens

• insects,

•  Foods: reaction slower than insects, except peanuts which have a severe and rapid onset. Most allergic to one food allergic to related, except peanuts

• Plants: poison ivy ect can cause rash that's actually allergic reaction, as well as pollen. ⅔ pop allergic to oil on poison ivy

• Meds:allergic to one can mean allergic to related, antibiotics especially, but some think allergic and not, just side effects

• Other like dust, chemicals, soap, makeup, ect

• Latex allergies are of concern in ems, patients likely to have had surgery many times, and providers can also develop latex allergy from prolonged exposure.

progression of allergies

• Allergic reactions do not occur 1st time a person encounters an allergen

  • First time body forms antibodies, which are bodies attempt to attack, antibody will combine only with allergen it was formed for or one similar

  • On second+ antibodies combine with allergen, combination causes release of histamine, which have many affects

some things allergic reaction can cause and effects

• anaphylaxis, like vasodilation, leaky capillaries, bronchoconstriction, mucus in lungs

  • Dilation of blood vessels reduces amount of blood returning to heart increases risk of shock, skin also flushes as blood vessels near surface open

  • When capillaries leaky, fluid moves into tissue and appears as swelling (angiodema) especially around site it started and face, vocal cords can swell causing stridor and muffled voice

  • Also can get urticaria (hives) red itchy, possibly raised splotches

  • Bronchoconstriction and mucus causes wheezing and hard to breathe

  • Irritation of nerve endings cause itching

S+S of allergic reactions

itching

hives

• Flushing

• Swelling

• Warm tingling feeling

• Tightness in throat/chest

• Coughing

• Rapid breathing

• Labored

• Hoarseness, muffled voice, loss of voice

• stridor/wheezing

• Increased heart decreased bp

• Itchy watery yes

• Headache

• Runny nose

• Impending doom

• Ams

• Flushed dry or cool pale clammy skin

• nausea/vomiting

• Increased pulse/respirations decreased bp

anaphylaxis vs allergic reaction

system	allergic	anaphylaxis
Respiratory complaints	sneezing/cough	dyspnea/tightness in chest
Respiratory sounds	normal	Wheezing muffled voice, stridor
Skin findings	Local hives/redness	Widespread hives, pallor, diffuse redness
swelling	Local swelling	Swelling of face lips eyes tongue mouth site
vitals	normal	Tachycardia, hypotension, tachypnea, decreased spo2
mental	Normal, maybe anxious	Syncope, ams, impending doom

how to treat shock

• For patients in shock keep them warm, supine, high flow oxygen

pediatrics and allergies

• Uncommon for young kids to have reactions, many kids grow out of reactions

auto injector

•  a syringe preloaded with meds that has a spring loaded device that pushes needle through skin when held against body

when to and not to give epi

• To find out if epinephrine is appropriate, contact med direction if patient exposed to past allergen or has s+s of anaphylaxis, and if has epi pen

  • If patient came in contact but no s+s, consult med direction, some patients have history of rapid onset, so may wish to give even if looks like dont need it

  • If patient has s+s and contact but no epi, treat for shock and transport or contact als 

what to do if med direction allows epi

• If med direction says yes, assist with med, document results, transport, reassess 2 minutes after application, record reassessment

epinephrine

• a hormone in the body that as a med constricts blood vessels and dilates bronchioles, makes capillaries less leaky. Many people with past history cary with them. Trade name adrenalin

How to use epi pen

• To use make sure you have 5 rights

• To use epi, make sure not cloudy or expired, remove safety cap, place against thigh (outside between waist and knee) and hold for 10 seconds, (works through clothing) dispose in biohazard container, reassess 2 minutes after expecting to see increase in pulse

side effects of epi

• Dizziness

• Pallor

• Chest pain

• Headache

• Nausea

• Vomiting

• excitability/anxiety

• Epinephrine also makes the heart beat stronger which is helpful during shock, but can also cause patients heart to work too hard, which is why historically we were told not to give unless prescribed to the patient.

how to use auvi q

• remove outer case and follow voice instructions, pull off red safety, put black end on thigh, hold for at least 5 seconds, put case on again and dispose in bio container

• Make sure if patient has extra epi pen to bring it onboard

Ready check inject system

• Only epi allowed to be carried is 1mL of (1:1000) concentration (contains 1 mg of epi in Ml)

• Second provider must verify proper doe pulled

• Syringe and needle proper size

• All supplies in one container with review card

• Emts need extra training to use

• Intramuscular

• agency maintains records of training

steps of administering syringe epi

1. . Open kit, very components present and not expired

2. Attach needle to syringe

3. Attach filter straw to syringe

4. Remove cap from med vial and clean top of vial with alcohol pad

5. Remove top from med ampule insert filter straw into epi ampule, withdraw appropriate volume

6. Insert needle into epi vial and withdraw appropriate volume

7. Remove straw and attach needle

8. Remove air bubbles from syringe and expel any additional air/fluid to reach correct volume

9. Confirm 5 rights and ensure no airbubbles

10. Have person 2 inspect

11. Identify site, flatten skin, insert at 90 angle, draw plunger quickie back, then depress slowly to inject

12. Remove syringe and activate needle safety mechanism, document administration