EDN - anaphylaxis

anaphylaxis

It is a life-threatening hypersensitivity or pseudoallergic reaction to exogenous agent. These severe reactions can be either immune mediated or chemically mediated in nature

anaphylactic reaction

this is a reaction that need prior exposure to allergens

anaphylactoid

this is a reaction that may occur without prior exposure to allergens

1st exposure

in anaphylactic reactions, ______ no allergic occurs

2nd exposure

in anaphylactic reactions, ______ allergies occur because antibodies are already developed

igE or immunoglobulin E

The initial exposure to the allergy-inducing agent (allergen) results in the formation of antibodies called

primary immune response

The initial exposure to the allergy-inducing agent (allergen) results in the formation of antibodies called IgE or Immunoglobulin E, where the first exposure is called

secondary immune response

Subsequent exposure to the allergen produces a

degranulation

The antigen and the IgE interact to trigger rupture of mast cells called

histamine

what is the ost important cause of symptoms of anaphylaxis

antihistamine

medicine of choice for allergies.

epinephrine, hydrocortisone, diphenhydramine and chlorphenamine, terbutaline

In the ER, no matter what allergy is presented, if there are signs of redness in the skin or difficulty in breathing, use these 3 medicines

0.5 mg IM or SQ

dose of epinephrine and site

vastus lateralis

what part of the body do we inject epinephrine

100-250 mg IV bolus

dose for hydrocortisone

hydrocortisone

this drug decreased inflammation within the airways

50 mg IV bolus

dose for diphenhydramine or chlorphenamine

diphenhydramine/chlorphenamine

this is a component of neozep

raise side rails it’s a drowsy drug

nursing consideration for diphenhydramine and chlorphenamine

hypotension and dizziness

if diphenhydramine and chlorphenamine is administered via IV, watch out for

terbutaline

If the case of the patient is not that severe, this is given second in line after epinephrine as beta-2 adrenergic agonist drug

terbutaline

this is given in pregnant women to control premature contractions

epinephrine, o2, antihistamines or beta 2 agonists, corticosteroids

mx for anaphylaxis

insect stings

These are injected poisons that can produce either local or systemic reactions by an insect

bee stung

most common insect sting is _________

honeybee, wasp, yellow jacket, hornet

common insects to stung you

honeybee

this insect stings when threatened and leaves behind stinger

wasp

this insect’s legs dangle when flying and it doesnt leave a stinger

yellow jacket

this insect nest in or on the ground, it doesnt leave stinger but it can cause skin infection

fire ants

this insect sting multiple times and onset is quick

hornet

this insect is yellow faced and white face, their nests resemble papier mache

erythema, pain, edema at the site of injury, pruritus, angioedema

local reactions of insect stings

bronchospasm, unconsciousness, laryngeal edema, cardiovascular collapse

systemic reactions of insect stings

epinephrine, diphenhydramine or chlorphenamine IM or IV

drugs for insect stings

hydrocortisone

drugs for bronchospasm

PLR

what fluid of choice for insect stings

snakebites

A toxicologic emergency because of envenomation from snakebites.

pit vipers, coral snakes

common snakes with poisons

pit vipers

with triangular heads, vertical pupils, indentations between the eyes and nostrils, and long fangs

coral snakes

small, brightly colored with short fangs and teeth behind them, and with a series of bands of yellow, red, yellow, and black (in that order);Walo-walo snake most popular in the Philippines, blue/silver and black strands)

walo - walo

what is the most popular coral snake in the ph with blue/silber and black strands?

ordinary blister

accumulation of the plasma from the third space

hemorrhagic blister

blood accumulation

antivenin

drug to administer for snakebite pt

allergic reaction

what to watch out for antivenin

vasopressors (dopamine, dobutamine)

aside from antivenin, these drugs are also given to treat shock

seizures

watch out for ____ because snakebites can cause neurologic paralysis which could alter the firing of electrical activity in the brain

hemorrhagic blisters

_______ will decrease the hemoglobin and hematocrit of the pt

jellyfish sting

These are injected poisons caused by jellyfish (e.g. Box jellyfish, locally known as Kwatro Kantos)

kwatro kantos

box jellyfish is locally known as

caramoan islands in camarines sur

Recent recorded sensational death due to jellyfish sting happened in

Irukandji syndrome

it is a painful, potentially lethal condition caused by sting and envenomation from multiple jellyfish species

severe pain, cramping, hypertension, cardiac complications (catecholamine surge)

Irukandji syndrome is characterized by

Cairns, in North Queensland

irukandji was named after the Aboriginal tribe (seafaring tribe) in located near ________________ in Australia, in the area where the syndrome was first reported

epinephrine and norepinephrine

the sting from the jellyfish causes oversecretion of___________________in the body, that is why there is hypertension, heart overexertion, and heart complications leading to cardiac death.

atrial and ventricular ectopy

ECG of jellyfish sting px reveals

back pain, diffuse muscle cramping, N and V, anxiety agitation, piloerection, tachycardia, hypertension

systemic symptoms of jellyfish sting

hot water (43-45 deg)

if the jellyfish sting is mild, soak the skin in ___________ until pain eases approximately 20-30 mins