Readings

• According to BLS, common allergens include penicillin/other antibiotics, latex, venom of bees/wasps/hornets, seafood, nuts/strawberries/melons/eggs/bananas and sulphites(food and wine preservatives)
• BLS says that in allergies, check for the site, auscultate lungs and look at the skin for erythema, urticaria, and edema
• BLS says to consider anaphylaxis if PT presents with 2 or more compromised body systems
• S/S of anaphylaxis in the respiratory system: dyspnea, wheezing, stridor/hoarse voice
• S/S of anaphylaxis in Cardiovascular system: tachycardia or hypotension/shock
• S/S of anaphylaxis in the neurological system: dizziness, confusion and loss of conciousness
• S/S of anaphylaxis for the GI system: Nausea, vomiting, diarrhea and abdominal cramps
• S/S of anaphylaxis in the Integumentary system: facial, orolingual or generalized swelling/urticaria
• According to BLS, historical findings of suspected anaphylaxis are: dysphagia, dyspnea, feelings of fear/anxiety/agitation/confusion/doom and general itching
• According to BLS, for suspected allergy prepare for cardiac arrest, airway obstructions, anaphylaxis, bronchospasm and hypotension
• Diphenhydramine is benadryl
• Diphenhydramine can only be used if PT weighs 25 kg or greater and Epinephrine can only be used for anaphylaxis only
• To treat anaphylaxis: administer EPI dose at 0.01 mg per kg with the max being 0.5 mg. (It can be rounded to the nearest 0.05 mg). The route is IM and you must wait 5 minutes before giving another dose. The max # of doses is 2
• For administrations of diphenhydramine when PT weighs more than 25 kg but less than 50: give a dose of just 25 mg(Max also). Route is IV/IM
• For administrations of diphenhydramine when PT weighs more than 50 kg: give a dose of just 50 mg(max as well)
• EPI admin takes priority over IV access
• In Cellular immunity, the body produces T cells that destroy and attack invaders while in Humoral immunity, B cells make antibodies in response to antigens
• IgE antibodies are produced in allergic reactions
• The antibody IgE direct mast cells and basophils to release substances that cause inflammation(histamine)
• Penicillin and allergies to other antibiotics are the most common cause of anaphylaxis
• Localized reactions of insect stings are not risk factors for anaphylaxis while adults who develop generalized urticaria are
• Common food allergies are: peanuts, cow's milk, wheat, soy and eggs
• IgE stands for immunoglobulin E
• Histamine increases vascular permeability
• Histamine increases bronchoconstriction and mucus production
• Histamine vasodilates vessels and can lead to extreme hypotension and shock.
• Pruritus is known as itching
• GI symptoms of anaphylaxis: abdo cramping/pain, nausea, bloating, vomitting, diarrhea and abdo distention
• Anaphylactic reaction can have an initial and delayed response.
• Anaphylaxis can be protracted, meaning it last days or onset of symptoms may occur later
• Anaphylaxis at the airway: angioedema may be present with stridor or hoarseness sounds due to swelling.
• Absence of wheezing during anaphylaxis may be a bad sign cuz it indicates very less air is moving in.
• Tachycardia, hypotension and shock are signs within circulation for anaphylaxis
• Medical history of an anaphylactic PT is important; PT may have taken an antihistamine and are not presenting with urticaria or they may be on beta blockers so they're not tachycardic
• ABCs should not delay administrations of EPI for anaphylaxis
• EPI suppresses the release of histamine and other chemicals that cause inflammation
• IV sol'n of EPI compared to IM is 10 x more dilute
• IM is preferred over IV for EPI doses. It's when repeated EPI docks are required or shock persists in spite of IM, that IV for EPI is indicated
• In some circumstances(pt is on beta blocker), glucagon is administered instead of EPI as it acts intracellularly and does not act on beta receptors. Nausea and vomiting are side effects.
• For PTs in refractory hypotension due to anaphylaxis, vasopressors such as Levophed are considered