Management of Allergic Reactions and Suspected Anaphylaxis December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Allergic Reactions Allergic reactions are very common and increasing in Australia and New Zealand, affecting around 1 in 3 people. St John members need to know how to help someone who is having an allergic reaction at an event. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Allergic Reactions Allergy occurs when a person's immune system reacts to substances in the environment that are harmless for most people. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Allergic Reactions These substances are known as allergens and are found in house dust mites, pets, pollen, insects, moulds, foods and some medicines. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis The immune system Responsible for detecting potentially infectious agents and clearing them from the body. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis The immune system Lymphatic vessels and lymph nodes carry lymph, a clear fluid containing white blood cells. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis The immune system The lymphatic vessels collect and direct lymph back into the blood circulation. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Allergic Reactions Atopy is the genetic (inherited) tendency to develop allergic diseases. People with atopy are said to be atopic When atopic people are exposed to allergens they can develop an immune reaction that leads to allergic inflammation (redness and swelling). December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Allergic Reactions The reaction can vary from mild to severe The reaction can occur in or on the: Skin Eyes Airway (including the nose) Gastrointestinal (GI) system December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Signs and Symptoms Mild / Moderate Tingling mouth Swelling (eyes, face, lips) Hives Body rash Itching Vomiting and/or abdominal pain December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Signs and Symptoms December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Signs and Symptoms December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Signs and Symptoms December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Signs and Symptoms December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Signs and Symptoms December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Signs and symptoms December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Management DRSABCD Determine if the patient is ‘at risk’ Ensure the patient rests Measure vital signs (RR, HR, BP, LOC) If topical in nature, apply Stingose Observe and assess for improvement Observe for Anaphylaxis Escalate care if concerned December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Histamine When the allergen (for example, pollen) enters the body, it triggers an antibody response. The antibodies attach themselves to special cells, called mast cells. When the pollen comes into contact with the antibodies, the mast cells respond by releasing certain substances, one of which is called histamine. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Histamine Normally, histamine stimulates two receptors found within the body. H1 receptors cause bronchoconstriction and increases movement through the GI tract. H2 receptors cause peripheral vasodilation and the release of gastric acid. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Histamine Combined, these reactions reduce the chances of more antigens entering the body, and remove them from the body more quickly. Histamine also causes the body to release its water into the tissue space, to help bring more white blood cells to the site of infection December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Histamine Unfortunately, this process goes into overdrive during an allergic reaction. People with allergies appear to release a much larger amount of histamine than normal. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Histamine The H1 and H2 receptor sites are overstimulated, causing such reactions as runny or stuffy nose, sneezing, wheezing, and watery and itchy eyes. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Antihistamine An antihistamine is a type of pharmaceutical drug that opposes the activity of histamine receptors in the body Claratine & Telfast are the two used by St John. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Antihistamine Indications for use Seasonal allergy – such as sneezing, itching, watery eyes, or runny nose: This is the only authorised use for Event Health Services. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Antihistamine Indications for use Antihistamines are not to be used by Advanced Responders for systemic allergic reactions. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Antihistamine Precautions  Profound hypertension  Renal impairment  Epilepsy or convulsion risk  Pregnancy or lactation  Intoxication with alcohol December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Antihistamine Action  H1-receptor antagonist December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Antihistamine Side effects  dry mouth  fatigue  dizziness December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Antihistamine Form of medication Fexofenadine (Telfast) Tablet — 180 mg Loratadine (Claratine) Tablet – 10mg December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Antihistamine Dose/Administration Exclude all signs of systemic allergic reaction Check and record vital signs, including BP. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Antihistamine Dose/Administration Adult: 1 tablet (regardless of the selected agent) swallowed with water. Maximum dose — 1 tablet in any 24hour period December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Antihistamine Dose/Administration Child: do not administer to a child under 12 years old. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis The most severe form of an allergy. It is much less common than a normal allergic reaction. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Becomes anaphylaxis when more than one body system is affected (example: altered LOC, wheeze and facial swelling). Anaphylaxis is a life threatening medical emergency that needs immediate medical attention. Ring 000. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis The body is overwhelmed by its own immune response - body is attacking itself. The allergen usually reaches the bloodstream very quickly, and circulates widely throughout the body. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis This is why intravenous medications and chemicals are often the cause of severe anaphylaxis. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis As well as hymenoptera – the class of insects that includes sawflies, wasps, bees, and ants – stings. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Signs and symptoms Determining whether someone is having an anaphylactic reaction at an event can be very difficult. Symptoms and severity vary. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Signs and symptoms They usually present within 20 mins - 2 hours after initial exposure to a trigger. However they may present up to 24 hours after exposure. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Signs and symptoms A quick response by members and a proper patient assessment is critical. RR, HR, BP, LOC December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Signs and symptoms During anaphylaxis massive amounts of fluid shift out of the blood vessels and into the tissue space. Volume loss, along with dilatation of blood vessels causes ↓BP December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Signs and symptoms The heart rate increases to compensate for the ↓BP and ↑Hypoxia December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Signs and symptoms Major swelling can occur in the patient's facial, neck and upper and lower airway tissues, compromising the airway and making it harder to breathe.  December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Signs and symptoms December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Signs and symptoms December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Signs and symptoms December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Signs and symptoms The GI system is overstimulated as well, causing nausea and possibly vomiting to occur.  December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Signs and symptoms May include one or more of the following: Altered LOC. Short of Breath Wheeze or persistent cough Facial swelling including lips, tongue, eyes. Sweating Nausea/vomiting Dizziness Hypotension December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Epinephrine Epinephrine is the frontline treatment for Anaphylaxis When your on duty you should have access to an Epipen and an Epipen Jnr December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Epinephrine The body produces epinephrine naturally through the adrenal glands. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Epinephrine Epinephrine increases heart rate (chronotropy) and contractility (inotropy). December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Epinephrine It also constricts the peripheral vascular system. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Epinephrine These effects combine to ↑BP December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Epinephrine It also causes the bronchioles to dilate, improving airflow to the alveoli. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Epinephrine As in other disease processes, the faster anaphylaxis sets in, the less likely the body can compensate and the more likely it will be fatal. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Epinephrine Administer Epinephrine (Epipen) as early as possible. If you think its Anaphylaxis don't delay! December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Management DRSABCD Call for help; escalate care immediately (ambulance and/or health professional) Rest the patient Rapid aggressive support of the patients Airway, Breathing & Circulation if needed. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Management Assess vital signs (RR, HR, BP, LOC) Administer Oxygen Administer Salbutamol Administer Adrenaline 0.3mg (300mcg) for adults 0.15mg (150mcg) for children December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Management Adrenaline Note the time given (OB12). Monitor vital signs closely for evidence of deterioration (RR, HR, BP, LOC) December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Management Adrenaline While waiting for the ambulance, after 5 min of first Epipen, if they are still having trouble, administer another Epipen (if available). December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Management If patient becomes unresponsive and is not breathing normally, commence CPR and apply AED. December 2013 Allergies Anaphylaxis

Allergies Anaphylaxis Management Salbutamol Patients with a persistent wheeze should be given Salbutamol This will NOT prevent or relieve upper airway obstruction, hypotension or shock. December 2013 Allergies Anaphylaxis

Coffs Harbour Divisional Training Questions 22 September 2018 Coffs Harbour Divisional Training