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Project: Ghana Emergency Medicine Collaborative
Document Title: Anaphylaxis
Author(s): Peter Moyer (Boston University), MD...
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for more information see: http://open.umich.edu/wiki/AttributionPolicy

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{ Content the ...
Defini)on	
  	
  
•  A	
  rapid	
  onset	
  allergic	
  reac)on	
  which	
  may	
  be	
  
life	
  threatening	
  	
  
•  Tr...
Terminology	
  
•  Anaphylaxis	
  -­‐	
  IgE	
  mediated	
  aEer	
  previous	
  
exposure	
  
•  Anaphylactoid	
  -­‐	
  n...
Common	
  Causes	
  
•  Drugs	
  
	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  b	
  lactam	
  an)bio)cs:	
  penicillins...
Common	
  Causes	
  	
  
•  Foods	
  and	
  addi)ves	
  –	
  more	
  common	
  in	
  children	
  
	
  	
  	
  	
  	
  	
  ...
Common	
  Causes	
  
• 
• 
• 
• 

S)ngs	
  
Vaccines	
  
Latex	
  
X-­‐Ray	
  contrast	
  material	
  	
  

7	
  
Pathophysiology	
  	
  
•  Release	
  of	
  vasoac)ve	
  and	
  bronchial	
  mediators	
  
from	
  mast	
  cells	
  and	
 ...
Clinical	
  Picture	
  
•  2	
  or	
  more	
  of	
  following:	
  
	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  ski...
Clinical	
  Picture	
  
•  Hypotension	
  -­‐	
  distribu)ve	
  shock	
  
	
  
•  GI	
  -­‐	
  cramps	
  and	
  vomi)ng	
 ...
Clinical	
  Picture	
  
•  Rapid	
  onset	
  -­‐	
  minutes	
  to	
  hours,	
  most	
  within	
  1	
  
hour	
  	
  

11	
 ...
Recurrence	
  
•  Up	
  to	
  20%	
  recur	
  within	
  8	
  hours	
  

12	
  
Treatment	
  
•  1st	
  line:	
  	
  
•  Epinephrine	
  	
  
	
  	
  	
  	
  	
  	
  	
  	
  	
  	
  -­‐	
  has	
  both	
 ...
Treatment	
  
•  Epinephrine	
  dosing	
  and	
  administra)on	
  
o 

o 
o 

0.3	
  (kids)	
  to	
  0.5	
  mg	
  (adults)...
Treatment	
  	
  
•  Epinephrine	
  –	
  if	
  refractory	
  to	
  IM	
  Rx	
  or	
  
cardiovascular	
  collapse	
  –	
  0...
Treatment	
  
•  Shock	
  –	
  IV	
  fluids	
  wide	
  open	
  

16	
  
Treatment	
  	
  
•  IV	
  steroids	
  and	
  an)histamines	
  (H1	
  and	
  H2	
  
blockers)	
  to	
  prevent	
  recurren...
Observa)on	
  
•  Admit	
  or	
  observe	
  for	
  8	
  hours	
  to	
  watch	
  for	
  
recurrence	
  

18	
  
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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 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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Transcript of "GEMC - Anaphylaxis - Resident Training"

  1. 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. 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. 3. Defini)on     •  A  rapid  onset  allergic  reac)on  which  may  be   life  threatening     •  True  emergency  –  requires  immediate   diagnosis  and  Rx   3  
  4. 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. 5. Common  Causes   •  Drugs                          b  lactam  an)bio)cs:  penicillins  and                    cephalosporins                          aspirin  and  other  NSAIDs                          sulfa  drugs                          aminoglycosides     5  
  6. 6. Common  Causes     •  Foods  and  addi)ves  –  more  common  in  children                      shellfish                      nuts                      milk                        eggs                      sulfites                      wheat                        soybeans   6  
  7. 7. Common  Causes   •  •  •  •  S)ngs   Vaccines   Latex   X-­‐Ray  contrast  material     7  
  8. 8. Pathophysiology     •  Release  of  vasoac)ve  and  bronchial  mediators   from  mast  cells  and  basophils  (histamines,   prostaglandins,  leukotrienes,  etc.)   8  
  9. 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. 10. Clinical  Picture   •  Hypotension  -­‐  distribu)ve  shock     •  GI  -­‐  cramps  and  vomi)ng   10  
  11. 11. Clinical  Picture   •  Rapid  onset  -­‐  minutes  to  hours,  most  within  1   hour     11  
  12. 12. Recurrence   •  Up  to  20%  recur  within  8  hours   12  
  13. 13. Treatment   •  1st  line:     •  Epinephrine                        -­‐  has  both  alpha  and  beta-­‐2  effects                        -­‐  reduces  mucosal  edema,  reduces    capillary    leakage,  vasoconstricts,    bronchodilates                                   13  
  14. 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. 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. 16. Treatment   •  Shock  –  IV  fluids  wide  open   16  
  17. 17. Treatment     •  IV  steroids  and  an)histamines  (H1  and  H2   blockers)  to  prevent  recurrence     17  
  18. 18. Observa)on   •  Admit  or  observe  for  8  hours  to  watch  for   recurrence   18  
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