GEMC - Anaphylaxis - Resident Training

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This is a lecture by Dr. Peter Moyer from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the …

This is a lecture by Dr. Peter Moyer from the Ghana Emergency Medicine Collaborative. To download the editable version (in PPT), to access additional learning modules, or to learn more about the project, see http://openmi.ch/em-gemc. Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/.

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  • 1. Project: Ghana Emergency Medicine Collaborative Document Title: Anaphylaxis Author(s): Peter Moyer (Boston University), MD, MPH 2012 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/ We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. These lectures have been modified in the process of making a publicly shareable version. The citation key on the following slide provides information about how you may share and adapt this material. Copyright holders of content included in this material should contact open.michigan@umich.edu with any questions, corrections, or clarification regarding the use of content. For more information about how to cite these materials visit http://open.umich.edu/privacy-and-terms-use. Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition. Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers. 1  
  • 2. Attribution Key for more information see: http://open.umich.edu/wiki/AttributionPolicy Use + Share + Adapt { Content the copyright holder, author, or law permits you to use, share and adapt. } Public Domain – Government: Works that are produced by the U.S. Government. (17 USC § 105) Public Domain – Expired: Works that are no longer protected due to an expired copyright term. Public Domain – Self Dedicated: Works that a copyright holder has dedicated to the public domain. Creative Commons – Zero Waiver Creative Commons – Attribution License Creative Commons – Attribution Share Alike License Creative Commons – Attribution Noncommercial License Creative Commons – Attribution Noncommercial Share Alike License GNU – Free Documentation License Make Your Own Assessment { Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. } Public Domain – Ineligible: Works that are ineligible for copyright protection in the U.S. (17 USC § 102(b)) *laws in your jurisdiction may differ { Content Open.Michigan has used under a Fair Use determination. } Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (17 USC § 107) *laws in your jurisdiction may differ Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that your use of the content is Fair. 2   To use this content you should do your own independent analysis to determine whether or not your use will be Fair.
  • 3. Defini)on     •  A  rapid  onset  allergic  reac)on  which  may  be   life  threatening     •  True  emergency  –  requires  immediate   diagnosis  and  Rx   3  
  • 4. Terminology   •  Anaphylaxis  -­‐  IgE  mediated  aEer  previous   exposure   •  Anaphylactoid  -­‐  not  IgE  but  immune  complex   complement  mediated;  no  prior  exposure   required   •  Therapeu)cally  iden)cal     4  
  • 5. Common  Causes   •  Drugs                          b  lactam  an)bio)cs:  penicillins  and                    cephalosporins                          aspirin  and  other  NSAIDs                          sulfa  drugs                          aminoglycosides     5  
  • 6. Common  Causes     •  Foods  and  addi)ves  –  more  common  in  children                      shellfish                      nuts                      milk                        eggs                      sulfites                      wheat                        soybeans   6  
  • 7. Common  Causes   •  •  •  •  S)ngs   Vaccines   Latex   X-­‐Ray  contrast  material     7  
  • 8. Pathophysiology     •  Release  of  vasoac)ve  and  bronchial  mediators   from  mast  cells  and  basophils  (histamines,   prostaglandins,  leukotrienes,  etc.)   8  
  • 9. Clinical  Picture   •  2  or  more  of  following:                            skin                                              pruritus                                                                                ur)caria                              respiratory                                                upper  airway                                                                              lump  in  throat                                                                              hoarseness                                                                              stridor                      lower  airway                          bronchoconstric)on                        wheezing                                                                                                                                                         9  
  • 10. Clinical  Picture   •  Hypotension  -­‐  distribu)ve  shock     •  GI  -­‐  cramps  and  vomi)ng   10  
  • 11. Clinical  Picture   •  Rapid  onset  -­‐  minutes  to  hours,  most  within  1   hour     11  
  • 12. Recurrence   •  Up  to  20%  recur  within  8  hours   12  
  • 13. Treatment   •  1st  line:     •  Epinephrine                        -­‐  has  both  alpha  and  beta-­‐2  effects                        -­‐  reduces  mucosal  edema,  reduces    capillary    leakage,  vasoconstricts,    bronchodilates                                   13  
  • 14. Treatment   •  Epinephrine  dosing  and  administra)on   o  o  o  0.3  (kids)  to  0.5  mg  (adults);  (0.3-­‐0.5ml  of  1:1000)  IM   in  thigh   Repeat  q  5  min  as  necessary     Epinephrine  auto  injector  (Epipen)  is                         easiest  and  safest  (comes  in  0.3  and  0.5  mg  dosages)                           14  
  • 15. Treatment     •  Epinephrine  –  if  refractory  to  IM  Rx  or   cardiovascular  collapse  –  0.1  mg  IV  epi  over   5-­‐10  minutes  (0.1  mg  of  the  1:10,000)       15  
  • 16. Treatment   •  Shock  –  IV  fluids  wide  open   16  
  • 17. Treatment     •  IV  steroids  and  an)histamines  (H1  and  H2   blockers)  to  prevent  recurrence     17  
  • 18. Observa)on   •  Admit  or  observe  for  8  hours  to  watch  for   recurrence   18