by Khesrawpopalzai sign and symptoms + management of Anaphylaxis Allergy Case analysis Urticaria Angioedema

1. ANAPHYLAXIS
Dr . Khesraw “ Popalzai “BY :
786

2. Allergy
Allergy is defined as a
hypersensitive state
Because of antigen
and and antibody .
Antigen
Antibody
Allergy

3. Allergic Reaction
 Immediate Type 1 (
Antibody in blood ) “
Anaphylaxis
 Delayed Type 2 (Antibody in
Tissues ) “ contact type A.
reaction”

4. Cases
 Case 1
In February 2011, a 30 year old lady
died of anaphylactic shock at a dental
practice in Brighton
the patient began to feel unwell and
complained of 'feeling hot and had an
itchy back and leg' she then collapsed
and fell from the dental chair onto the
floor
staff were led to believe that she was
suffering an epileptic shock and as
such did not administer adrenaline.
 Case 2
This recent case follows a death in
Cumbria in 2009 where a male
patient response to chlorhexidine.
Chlorhexidine had been
administered to irrigate a tooth
socket, resulting again
?

5. An Epileptic shock , Cardiac arrest or an Anaphylactic shock ???
What is the Answer ?
HYPOTENSIO
N

6. Anaphylaxis
An acute hypotension and often
bronchospasm and Urticaria caused largely by
Histamine release as sequence of an acute
type 1 allergic response .
Anaphylactic reactions usually result from drug
administration or reaction to an allergen in
impression material or other materials used in
the oral cavity. The most frequent cause is
related to drug administration .
Tissues in different parts of the body release histamine
and other substances.

7. Emergency presented very quickly and there was very little time
for practitioners to respond
There are a number of lessons that should be learned from these
cases:
Lesson
s
CASE 1
It is essential that practitioners are able to recognize and manage
anaphylactic shock appropriately
In the case of the first patient described here, it was noted that there
were few of the classic signs of anaphylaxis, making diagnosis
difficult. In the first case described, protocols were not available to
manage common medical emergencies and practitioners were
unprepared.
CASE 2

8. Sign and Symptoms
When
hypotension
occurs, it is termed
Anaphylactic Shock
Generalized
anaphylaxis involves
basically :
 Skin
 Cardiovascular
 Respiratory
 Gastrointestinal
1. Urticaria, itching, flushing,
hives 2. Rash 3. Rhinitis
4. Bronchospasm 5. Laryngeal
edema 6. Weak pulse-syncope
7. Loss of consciousness
8. Cardiac arrest

9. Skin
 Urticaria or
Wheal :
Smooth elevated patches
surrounded by
erythematous areas
 Angioedema
Non-inflammatory edema
involving
skin, subcutaneous tissue,
underlying muscle & mucous
membranes.
Occurs in response to allergen
Most critical in the larynx
 Erythema

10. Urticaria

11. Angioedema

12. Respiratory
 Wheezing
 Cyanosis
 tachycardia,
 use of accessory
muscles of
respiration

13.  Gastro Intestinal
 nausea
 vomiting
 Diarrhea
 incontinence
 Cardiovascular
 palpitations
 tachycardia,
 hypotension
 dysrhythmias
 loss of consciousness
 arrest
…

14. Management of Anaphylaxis
Place patient in a supine postion Nitroglycerin
 1. Basic life support
 2. Epinephrine, 0.3 to 0.5 ml IM or 0.1 IV
Acts as a physiologic antagonist to the events that occur during an allergic reaction
 3. Oxygen 10 – 15 lit
 4. Antihistamines Diphenhydramine, 50 ml IM
H-1 blocker
Inhibits action of histamine released during reaction to allergen
 5. Corticosteroids prednison (Administration of corticosteroids is to prevent relapse)
 6. Airway management-intubation or cricothyrotomy
Repeat epinephrine Q5min prn

15. 16x9
4x3
Conclusion
Essentially, the incidences of medical emergencies are rare.
It is unlikely that deaths due to anaphylaxis can be avoided in
dental practice but practitioners need to be aware of potential
risks and have the knowledge, skills, drugs and equipment
required to manage this unfortunate event should it occur.
Be prepared to manage difficulties!
Always!