Anaphylaxis Dr. Stella Yiu Emergency Physician, TOH.

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Presentation transcript:

Anaphylaxis Dr. Stella Yiu Emergency Physician, TOH

LMCC Objectives Acute/Chronic/Systemic illness Allergic reaction: Severity, cause Investigations Manage patient with urticaria and anaphylaxis

URTICARIA Photo credit: kiwinky, Flickr commons

50% has angioedema (lips/face/upper airway) If airway/tongue -> potential airway obstruction

© anaphylaxisweb

ACUTE/CHRONIC SYSTEMIC ILLNESS

Types of urticaria 1.Acute: – Self limiting – Onset < 30 minutes 2.Chronic (>6 weeks)

Urticaria: triggers Photo credit: ambert, cwulmer, Norm & Debra, FlickR creative commons

Systemic illness -> urticaria Serum sickness Transfusion reactions Viral/bacterial infections Vasculitis

Systemic illness: serum sickness Photo credit: mrmason.ca

Systemic illness: serum sickness Photo credit: mrmason.ca Fever, rash, arthralgia

Systemic illness: transfusion reactions Credit: online nursing CEUS

Systemic urticaria: Viral/Bacterial infection Photo credit: Dermatolog Information System

Systemic urticaria: Vasculitis Associated with SLE, Sjogren, Leukemia Drugs Systemic unwell: Arthralgia, fever, abdo pain, lymphadenopathy Photo credit: Dermatology image atlas

ALLERGIC REACTION

ANTIGEN MEETS CELLS -> IGE

© McGraw Hill

© anaphylaxisweb Does he have an anaphylaxis reaction?

Definition > 2 systems: CVS (  BP), airway, GI, skin Skin + airway/  BP  BP

Investigations for allergic reaction/anaphylaxis Acute urticaria/allergic reaction: None Chronic: Maybe CBC with ESR After reaction: Skin tests with allergist

MANAGEMENT

© McGraw Hill Antihistamines H1: Benadryl (Diphenhydramine) H2: Ranitidine

© McGraw Hill Fluids

© McGraw Hill Bronchodilators Epinephrine

Management Airway Breathing Circulation Drugs

Management Airway Breathing Circulation Drugs Epinephrine Intubate Bronchodilators Fluids, epinephrine iv Ranitidine Diphenhydramine

Discharge meds Steroid -  2 nd phase reaction (6-72 hours) - Prednisone po or solumedrol iv Continue Antihistamines

Discharge instructions Allergy testing outpatient Patient to carry Epi-Pen at all times Photo credit: gregfriese, flickr creative commons

Management: Angioedema ACE inhibitor Consider C1 esterase inhibitor concentrate or FFP

LMCC Objectives Acute/Chronic/Systemic illness Allergic reaction: Severity, cause Investigations Manage patient with urticaria and anaphylaxis