Anaphylaxis

Question 1

What is the first line treatment for anaphylaxis(what do you need to do first?)

Answer 1

1. Oxygen
2. Adrenaline(0,01mg/kg IM)
3. IV fluids

Question 2

What is the second line stuff you should do for anaphylaxis?

Answer 2

1. H1 antihistamine
2. Bronchodilators
3. corticosteroids

Question 3

What is the pathophysiology of anaphylaxis?

Answer 3

• It is a type 1 hypersensitivity reaction
• IgE mediated
• causing mast cells to degranulate and release histamine, serotonin and bradykinins if they come into contact with antigens

Question 4

What are the signs and symptoms of anaphylactic shock?

Answer 4

1. CVS: hypotension-vasodilation
2. RESP: angiooedema and bronchospasm
3. skin: rash and flushing
4. GIT: nausea, vomiting, diarrhoea and abdominal discomfort

Question 5

What are the clinical manifestations of anaphylaxis in patients under general anesthesia?

Answer 5

1. bronchospasm- there will be changes on capnography tracing
   There will be decreased tidal volume, increased airway pressure
2. Hypotension: BP might be so low we cannot trace it

Question 6

What are the clinical manifestations of anaphylaxis in patients under spinal?

Answer 6

1. bronchospasm- patients complains of tight chest, difficulty breathing and swallowing and stridor and voice changes occur
2. hypotension-untraceable

Question 7

Why must we wait before we give IV antihistamine?

Answer 7

-It is said to cause cardiac instability and so it can make things worse if the patient is not yet stable cardiacally and we give antihistamine

Question 8

Why must we not use MgSO4 in anaphylaxis?

Answer 8

-It is excellent for bronchospasm but it cause hypotension

Question 9

What is the management of anaphylaxis?

Answer 9

1. Stop the trigger-antibiotics, latex, muscle relaxants
2. Give 100% oxygen
3. Intubate the patient to protect the airway
4. Give adrenaline- 50-100 mcg boluses(start infusion later
5. Give IV fluid- crystalloid or colloid 10-20ml/kg
6. Other drugs-salbutamol(B-blocker)
   ranitidine, phenylephrine(vasopressor), glucagon