Anaphylaxis-1 - ANAPHYLAXIS Causes of anaphylaxis...

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ANAPHYLAXIS
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Causes of anaphylaxis Immunologic mechanisms IgE-mediated - drugs - foods - hymenoptera (stinging insects) - latex Non-IgE mediated - anaphylotoxins-mediated e.g. mismatched blood
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Causes of anaphylaxis Direct activation of mast cells - opiates, tubocurare, dextran, radiocontrast dyes Mediators of arachidonic acid metabolism - Aspirin (ASA) - Nonsteroidal anti-inflammatory drugs (NSAIDs) Mechanism unknown
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Causes of anaphylaxis Exercise-induced food-dependent, exercise-induced cold-induced idiopathic
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Risk of anaphylaxis Yocum etal. (Rochester Epidemiology Project) 1983-1987: incidence: 21/100,000 patient-years food allergy 36%, medications 17%, insect sting 15%
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Frequency of symptoms in Anaphylaxis Urticaria/angioedema 88% Upper airway edema 56% Dyspnea or wheeze 47% Flush 46% Dizziness, hypotension, syncope 33% Gastrointestinal sx 30% Rhinitis 16%
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Anaphylaxis Onset of symptoms of anaphylaxis: usually in 5 to 30 minutes; can be hours later A more prolonged latent period has been thought to be associated with a more benign course. Mortality: due to respiratory events (70%), cardiovascular events (24%)
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Prevention of anaphylaxis Avoid the responsible allergen (e.g. food, drug, latex, etc.). Keep an adrenaline kit (e.g. Epipen) and Benadryl on hand at all times. Medic Alert bracelets should be worn. Venom immunotherapy is highly effective in protecting insect-allergic individuals.
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Treatment of anaphylaxis EPINEPHRINE (1:1000) SC or IM - 0.01 mg/kg (maximal dose 0.3-0.5 ml) - administer in a proximal extremity - may repeat every 10-15 min, p.r.n. EPINEPHRINE intravenously (IV) - used for anaphylactic shock not responding to therapy - monitor for cardiac arrhythmias EPINEPHRINE via endotracheal tube
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Place patient in Trendelenburg position. Establish and maintain airway. Give oxygen via nasal cannula as needed. Place a tourniquet above the reaction site (insect sting or injection site). Epinephrine (1:1000) 0.1-0.3 ml at the site
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Anaphylaxis-1 - ANAPHYLAXIS Causes of anaphylaxis...

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