Anaphylaxis is a severe, life-threatening allergic reaction characterized by rapidly developing symptoms that affect the airway, breathing, and circulation. It is usually caused by exposure to an allergen that triggers an immune response involving immunoglobulin E (IgE) antibodies. Common triggers include stings, nuts, foods, medications, and latex. Treatment involves rapidly assessing the airway, breathing, circulation, disability, and exposure, administering epinephrine, supplemental oxygen, intravenous fluids, antihistamines, and corticosteroids, and monitoring the patient closely. Prompt recognition and treatment of anaphylaxis is critical in preventing fatalities.
Most about status asthmaticus, you will find from etiology to treatment and ventilator management. This presentation is made with thanks to medscape and other resources.
Most about status asthmaticus, you will find from etiology to treatment and ventilator management. This presentation is made with thanks to medscape and other resources.
DYSPNOEA IS DEFINED AS THE UNDUE AWARENESS OF UNPLEASANT BREATHING.WHEN THERE IS AMIS MATCH BETWEEN THE AFFERENT VENTILATORY SIGNALS AND THE EFFERENT RESPIRATORY SIGNALS IN THE BRAIN WE MAY GET AN UNIGNORABLE FEELING FOR NEED OF MORE AND MORE OXYGEN.
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Definition and Pathophysiology of Asthma in addition to classification and recent updates in the management of asthma based on GINA-2019 Guidelines, by Dr. Marco Makram.
To watch my animated viedo on YouTube visit
http://www.youtube.com/watch?v=nVHDGWfQhSU
To download my animated presentation visit:
https://www.dropbox.com/s/bbtayufrn1clnvh/Anaphylaxis.pptx
DYSPNOEA IS DEFINED AS THE UNDUE AWARENESS OF UNPLEASANT BREATHING.WHEN THERE IS AMIS MATCH BETWEEN THE AFFERENT VENTILATORY SIGNALS AND THE EFFERENT RESPIRATORY SIGNALS IN THE BRAIN WE MAY GET AN UNIGNORABLE FEELING FOR NEED OF MORE AND MORE OXYGEN.
Bronchial Asthma: Definition,Pathophysiology and ManagementMarko Makram
Definition and Pathophysiology of Asthma in addition to classification and recent updates in the management of asthma based on GINA-2019 Guidelines, by Dr. Marco Makram.
To watch my animated viedo on YouTube visit
http://www.youtube.com/watch?v=nVHDGWfQhSU
To download my animated presentation visit:
https://www.dropbox.com/s/bbtayufrn1clnvh/Anaphylaxis.pptx
This slide aims to inform readers about the characteristics of anaphylaxis, a highly serious type of allergy attack. It also gives a few tips on how to handle this disorder in an emergency.
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RESPONDING TO THE SYMPTOMS OF MINOR AILMENTSFOOD AND DRUG ALLERGY
Minor ailments are generally defined as medical conditions that will resolve on their own and can be reasonably self-diagnosed and self-managed with over the counter medications.
Community pharmacists are seen as one of the most accessible health care professions since many pharmacies can be found on the high street and no appointment is necessary.
Responding to symptoms is one of the important role of community pharmacist so as to be able to provide the proper pharmaceutical care.
They supply medicines in accordance with a prescription or when legally permitted, dispense them without a prescription.
FOOD ALLERGY
Food allergies occur when the body's immune system reacts to certain proteins in food.
Food allergic reactions vary in severity from mild symptoms involving hives and lip swelling to severe, life-threatening symptoms, often called anaphylaxis, that may involve fatal respiratory problems and shock.
There are many food allergies.
Food allergies occur when the body's immune system reacts to certain proteins in food.
Food allergic reactions vary in severity from mild symptoms involving hives and lip swelling to severe, life-threatening symptoms, often called anaphylaxis, that may involve fatal respiratory problems and shock.
There are many food allergies.
ROLE OF COMMUNITY PHARMACIST IN MANAGING FOOD ALLERGIES
DRUG ALLERGY
A drug allergy is the reaction of the immune system to a medicine.
Any medicine nonprescription, prescription or herbal can provoke a drug allergy.
Include inactive or nonmedicinal ingredients into computer allergy database.
Perform independent double checks during order entry and dispensing as well to prevent incidences of allergic reactions undetected by the computer software.
The pharmacist should instruct the patient to carry a Medic Alert card or bracelet to avoid future accidental prescription/dispensing of any drugs to which he or she is allergic.
Pharmacists should educate patients about drug allergies.
Patients and family members should be educated on the generic names of the drugs they are allergic to and other potentially cross-reacting drugs.
The pharmacist can also help families know if a related drug might cause a similar reaction
Pharmacists can help patients and families identify drug allergies by asking questions such as:
When did your reaction occur?
Have you had any recent drug changes?
What were your symptoms?
Does anything make you feel better or worse?
Whenever a person presents with a suspected drug allergy, a detailed record should be taken to include the generic and brand names of the drug, its strength and formulation and which drugs, or drug classes, should be avoided in future
Pharmacists can help treat drug allergies by stopping the drug, using a different dose or form of the drug, or using additional drugs to relieve allergy symptoms (Antihistamines, Corticosteroids).
Hospital & community pharmacy M.Pharm
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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Workshop Aug 2015: Anaphylaxis
1.
2.
3.
4. Anaphylaxis is:
–A severe, life-threatening, generalized or systemic
hypersensitivity reaction
Anaphylaxis is characterized by:
–Rapidly developing, life threatening, Airway and/or
Breathing and or Circulation problems
–Usually with skin and/or mucosal changes
5.
6. •Mainly children and young adults
•Commoner in females
•Incidence seems to be increasing
7.
8. Stings 47 29 wasp, 4 bee, ? 14
Nuts 32 10 peanut, 6 walnut, 2 almond, 2 brazil, 1 hazel, 11 mixed
or ?
Food 13 5 milk, 2 fish, 2 chickpea, 2 crustacean, 1 banana, 1 snail
? Food 18 5 during meal, 3 milk, 3 nut, 1 each - fish, yeast, sherbet,
nectarine, grape, strawberry
Antibiotics 27 11 penicillin, 12 cephalosporin, 2 amphotericin, 1
ciprofloxacin, 1 vancomycin
Anaesthetic drugs 35 19 suxamethonium, 7 vecuronium, 6 atracurium, 7 at
induction
Other drugs 15 6 NSAID, 3 ACEI, 5 gelatins, 2 protamine, 2 vitamin K, 1
each - etoposide, diamox, pethidine, local anaesthetic,
diamorphine, streptokinase
Contrast media 11 9 iodinated, 1 technetium, 1 fluorescine
Other 4 1 latex, 1 hair dye, 1 hydatid,1 idiopathic
Suspected triggers for fatal anaphylactic reactions in the UK between 1992‐2001
9.
10. Adapted from Pumphrey RS. Lessons for management of anaphylaxis from a
study of fatal reactions. Clin Exp Allergy 2000;30(8):1144-50.
11. Pathophysiology
Initial contact sensitizes the immune system
(does not produce clinical response)
A secondary reaction, mediated by IgE, causes
the clinical symptoms of anaphylaxis.
Antigens that stimulate the immune system to
produce IgE are called “Allergens”
12. Antigen Specific IgE
Fab
Fc
Mast Cell &
Basophils
Y Y YY Y Y
Mast Cell Mediators of Anaphylaxis:
Pre-Formed: Newly Formed:
Histamine Leukotrienes
Typtase, etc. Platelet-activating Factor
NCF-A Prostaglandin D2
13. •Immediate Hypersensitivity.
•Mediated By Ige
•Causes The Release of Histamine,
Leukotrienes
Prostaglandins
From Mastcells and Basophils.
•Usually Atopic (Familial Predisposition.
1. Ige Binds To Mast Cells
2. Antigen Cross Bridging
3. Histamine Release (Mast Cell Degranulation)
18. •Exposure to a known allergen/trigger
for the patient helps support the
diagnosis
19. •Skin or mucosal changes alone are not a sign of an
anaphylactic reaction
•Skin or mucosal changes can be subtle or absent in up to
20% of reactions (some patients can have only a decrease
in blood pressure i.e., a Circulation problem)
•There can also be gastrointestinal symptoms
(e.g. vomiting, abdominal pain, incontinence)
20. •Airway swelling e.g. throat and tongue swelling
•Difficulty in breathing and swallowing
•Sensation that throat is ‘closing up’
•Hoarse voice
•Stridor
21. •Shortness of breath
•Increased respiratory rate
•Wheeze
•Patient becoming tired
•Confusion caused by hypoxia
•Cyanosis (appears blue) –a late sign
•Respiratory arrest
22. •Signs of shock –pale, clammy
•Increased pulse rate (tachycardia)
•Low blood pressure (hypotension)
•Decreased conscious level
•Myocardialischaemia/ angina
•Cardiac arrest
DO NOT STAND PATIENT UP
23. •Sense of “impending doom”
•Anxiety, panic
•Decreased conscious level caused by airway,
breathing or circulation problem
24. •Skin changes often the first feature
•Present in over 80% of anaphylactic reactions
•Skin, mucosal, or both skin and mucosal changes
25. •Erythema–a patchy, or generalised, red rash
•Urticaria(also called hives, nettle rash,wealsor welts) anywhere on the body
•Angioedema-similar tourticaria but involves swelling of deeper tissues
e.g. eyelids and lips, sometimes in the mouth and throat
26. Life-threatening conditions:
•Asthma -can present with similar symptoms and
signs to anaphylaxis, particularly in children
•Septic shock –hypotension with
petechial/purpuricrash
32. Anaphylactic Reaction?
Assess : Airway, Breathing, Circulation, Disability, Exposure
Diagnosis-look for:
•Acute onset of illness •Life threatening features 1
•And usually skin changes
+/-Exposure to known allergen
+/-Gastrointestinal symptoms
Call for help
Lie patient flat and raise legs (if breathing not impaired)
Adrenaline
When skills and equipment available:
A. Establish airway
B. High flow oxygen Monitor:
C.IVfluidchallenge3 •Pulse oximetry
Chlorphenamine4 •ECG
Hydrocortisone5 •Blood pressure Anaphylactic
33. Intra-muscular adrenaline
Adrenaline
IM doses of 1:1000 adrenaline (repeat after 5 min if no better)
Adult or child more than 12 years: 500microgramsIM(0.5mL)
Child 6 ‐12 years: 300 micrograms IM(0.3mL)
Child 6 months ‐6 years: 150microgramsIM(0.15mL)
Child less than 6 months: 150 micrograms IM (0.15mL)
35. Anaphylactic Reaction?
Assess : Airway, Breathing, Circulation, Disability, Exposure
Diagnosis-look for:
•Acute onset of illness •Life threatening features 1
•And usually skin changes
+/-Exposure to known allergen
+/-Gastrointestinal symptoms
Call for help
Lie patient flat and raise legs (if breathing not impaired)
Adrenaline
When skills and equipment available:
A. Establish airway
B. High flow oxygen Monitor:
C.IVfluidchallenge3 •Pulse oximetry
Chlorphenamine4 •ECG
Hydrocortisone5 •Blood pressure Anaphylactic
36. •Once IV access established
•500 –1000mLIV bolus in adult
•20mL/Kg IV bolus in child
•Monitor response -give further bolus as necessary
•Colloid or crystalloid
(0.9% sodium chloride or Hartmann’s)
•Avoid colloid, if colloid thought to have caused reaction
37. •Second line drugs
•Use after initial resuscitation started
•Do not delay initial ABC treatments
•Can wait until transfer to hospital
38. Hydrocortisone (IM or slow IV)
Adult or child more than 12 years 200 mg
Child 6 - 12 years 100 mg
Child 6 months to 6 years 50 mg
Child less than 6 months 25 mg
39. Chlorphenamine(IM or slow IV)
Adult or child more than 12 years 10 mg
Child 6 - 12 years 5 mg
Child 6 months to 6 years 2.5 mg
Child less than 6 months 250 micrograms/kg
40. •Follow Basic and Advanced Life Support guidelines
•Consider reversible causes
•Give intravenous fluids
•Need for prolonged resuscitation
•Good quality CPR important
41. Ideal sample timing:
1.After initial resuscitation started and feasible
to do so
2. 1-2 hours after onset of symptoms
3. 24 hours or in convalescence or at follow up
42. •For self-use by patients or carers
•Should be prescribed by allergy specialist
•For those with severe reactions and difficult to
avoid trigger
43. •Train the patient and carers in using the device
•Practice regularly with a trainer device
•Rescuers should use these if only adrenaline available*
*see www.anaphylaxis.org.uk for videos on how to use auto-injectors
44. •Recognition and early treatment
•ABCDE approach
•Adrenaline
•Investigate
•Specialist follow up
•Education –avoid trigger
•Consider auto-injector
50. Assess Breathing
Look for chest movement
Listen for breath sounds
Feel for expired air
Assess for 10 seconds before
deciding breathing is absent
54. Rescue breathing
(Expired air ventilation)
After 30 compressions
Occlude victim’s nose
Keep mouth open
Maintain chin lift
Take a deep breath
Ensure a good mouth-to-
mouth seal
55. Rescue breathing
(Expired air ventilation)
Blow steadily (01 sec) into
victim’s mouth
Watch for chest rise
Maintain head tilt & chin lift,
remove mouth
Watch chest fall
Another rescue breath – total
2 rescue breaths