Allergy and Anaphylaxis in the ED.
A 22yr old lady develops generalized urticaria, light headedness and wheeze 10 minutes after eating chicken satay with peanut sauce. What is the appropriate first line treatment?
The lady has anaphylaxis and Adrenaline IM is the first line drug. Steroids and antihistamines are second line.
A 62yr old man develops anaphylaxis after a bee sting. Despite 2 doses of IM Adrenaline, IV fluids and supplemental 02 he remains hypotensive with a BP of 75/40. What is the next best step?
This is refractory anaphylaxis. Commence an adrenaline infusion with appropriate monitoring and link in with ICU.
A 45yr old lady presents with widespread urticaria after taking Amoxycillin. She has no respiratory symptoms, no cardiovascular compromise and normal observations. Which feature would most strongly indicate progression to anaphylaxis?
Hypotension is a key sign of anaphylaxis.
F.A.S.T. is a mnemonic to aid with the recognition of the symptoms in severe allergy. Which of the following is NOT true?
The T is for "Total Body"---essentially dizziness, collapse.
In the United States when the company "Mylan" acquired the rights to the "EpiPen" in 2007 how much did they subsequently retail the "2 pack EpiPen" for?
When Mylan took over, a single injection was about US $50. It cost them about US$ 30 max to make an EpiPen. So they made people pay nearly A $1000 for 2 EpiPens that last only 1 year. A true capitalist rip off of the US public.
An 18yr old lady presents with suspected anaphylaxis. Which combination of findings is most consistent with the diagnosis?
Classically skin changes and systemic symptoms.
Following a bee sting what is the generally accepted time frame for when anaphylaxis can set in?
It generally is pretty quick. If the allergen is introduced intravenously it can be extremely quick and conversely an oral allergen may take a few hours (or occur in minutes).
What is the reason for the hypotension in anaphylactic shock?
I would like to say it was all due to the CIA but it is not. Adrenaline reverses the venoconstriction and closes the inter cellular clefts that are opened in anaphylaxis and cause the leaks between cells.
A 7yr old boy with a weight of 25kg develops anaphylaxis after eating cashews. What is his IM dose of Adrenaline?
It is so dangerous isn't it. Check it everytime with another clinician. It is 10 micrograms per kilogram IM. But remember be careful----please. Bad stuff happens.
A 48yr old man develops severe stridor and rapidly progessing airway compromise despite IM and nebulised Adrenaline. Which of the following statements is most appropriate?
Bad situation. Prepare and get help--NOW. Upper airway closure needs a coordinated, calm team approach.