Differentiating between anxiety, syncope anaphylaxis and prompt management of anaphylaxis

1. Differentiating between anxiety,
syncope & anaphylaxis
And prompt Management of
Anaphylaxis

2. 2
Anaphylaxis
Anaphylaxis is an acute, potentially fatal, multiorgan
system reaction caused by the release of chemical
mediators from mast cells and basophils.
The classic form involves prior sensitization to an allergen
with later re-exposure, producing respiratory,
cardiovascular, cutaneous, or gastrointestinal
manifestations resulting from exposure.

3. 3
Syncope
Syncope is defined as a transient, self-limited loss of consciousness with an
inability to maintain postural tone that is followed by spontaneous
recovery.
Presyncopal symptoms reported may include the following:
– Prior faintness, dizziness, or light-headedness (70% of cases of true
syncope)
– Prior vertigo, weakness, diaphoresis, epigastric discomfort, nausea,
blurred or faded vision, pallor, or paresthesias
anxiety
The American Psychological Association (APA) defines anxiety as “an emotion
characterized by feelings of tension, worried thoughts and physical changes
like increased blood pressure.”
At our center we observed some symptoms such as:
1. nervousness, restlessness, or being tense
2. palpitations
3. Sweating
4. weakness and lethargy

4. 4
Anaphylaxis & Syncope & Anxiety
Manifestation
1. Onset
2. General disposition
3. Skin/Mucosa
4. Breathing
5. Blood Pressure
6. Abdomen/GI
7. Pulse

5. 5
Onset
ANAPHYLAXIS
 Usually slower
5-30 minutes after
immunization
 Sometimes onset not
for an hour
 Post recovery
prolonged
 20% are biphasic
with a second
phase 2-9 hours
SYNCOPE
 Sudden
 Before during or
immediately after
immunization
 Recovery within 1-2
min
ANXIETY
 Before, during or
shortly after
 •Recovery is usually
rapid

6. 6
General disposition
ANAPHYLAXIS
 Sense of impending
doom, agitation
 If loss of
consciousness:
 Usually have
warning signs
 Gradual fall to floor
 Tonic-clonic jerking
unlikely
SYNCOPE
 Light-
headedness/dizziness
 Numbness/weakness
 Tingling around
lips/extremities
 Slumping to floor
 Tonic/Clonic posturing
possible if hypoxia
severe enough
ANXIETY
 •Fearfulness
 •Light headedness/dizziness
 •Numbness/weakness
 •Tingling around lips and
extremities

7. 7
Skin/Mucosa
ANAPHYLAXIS
 Flushed, red
 Generalized hives
– Look at the
injection site
 Progressive painless
swelling about face,
mouth, tongue, uvula.
SYNCOPE
 Pale
 Excessive perspiration
 Cold and clammy
ANXIETY
 Pale
 Excessive perspiration
 Cold and clammy

8. 8
Breathing
ANAPHYLAXIS
 Sneezing,
 coughing,
 wheezing,
 difficulty
breathing
 Upper airway swelling
(indicated by
hoarseness and/or
difficulty swallowing)
SYNCOPE
 Normal or
 Shallow, irregular,
difficulty
ANXIETY
 Rapid
 Shallow

9. 9
Blood Pressure
ANAPHYLAXIS
 Decreased
SYNCOPE
 Decreased
ANXIETY
 Normal
 Elevated systolic
Abdomen/GI
ANAPHYLAXIS
 Persistent
 Nausea and vomiting
 Crampy, abdominal
pain, diarrhea
SYNCOPE
 Nausea
ANXIETY
 Nausea
Pulse
ANAPHYLAXIS
 Rapid, weak
SYNCOPE
 Slow
ANXIETY
 Rapid

10. 10

11. 11

12. 12
• American Family Physician - A Practical Guide to Anaphylaxis
(https://www.aafp.org/afp/2003/1001/p1325.html)
• UpToDate - Anaphylaxis: Emergency treatment
(https://www.uptodate.com/contents/anaphylaxis-emergency-treatment)
• Medscape - Drugs & Diseases -Emergency Medicine – Syncope
(https://emedicine.medscape.com/article/811669-overview)