1. Angelique Davis

2.  Type I IgE or Non-IgE Allergic reaction  Type II IgG, IgM, Complement mediated Cytotoxicity; Blood reaction  Type III Immune complex response Clumps form due to not enough antibody to rid antigen. Lupus, rheumatoid arthritis  Type IV Delayed; T-cell mediated response Bone marrow transplant rejection: Graft vs Host

3. ANAPHYLAXISANAPHYLACTOID  IgE mediated  Previous exposure to allergen  Can occur once in every 5,000-10,000 anesthetics  More frequent and more severe  Occurs within seconds to 5- 10 minutes  May be delayed onset 10- 12 hours  Non-IgE mediated  Can occur and act like IgE mediated anaphylaxis upon first exposure to allergen  Idiopathic  Less frequent  Difficult to distinguish between the two when reaction occurring

5.  Primarily concerned with mast cells and basophils, which are mostly found in the heart, vasculature, respiratory, GI tract, and integument  Histamine release Mucous secretion, edema, vasodilation, tachycardia, inflammation, cardiac depression  Leukotriene and prostagladin release Bronchoconstriction, angioedema, increased vascular permeability

6.  Pruitis  Malaise  Dizziness  Flushing  Erythema  Uticaria  Angioedema  Can anyone tell me why these signs may be difficult to recognize?

7. RESPIRATORYCARDIOVASCULAR  Wheezing  Hypoxia  Hypercarbia  Angioedema  High peak pressures  Hypotension  Tachycardia  Dysrhythmia's  Shock  Death

8.  Bronchospasm  Malginant Hyperthermia  Laryngospasm  Asthma  Drug overdose  Pulmonary Edema  Pneumothorax  Venous Air Embolism  Pericardial tamponade  Rapid infusion of vancomycin causes flushing (red man syndrome)

9.  Neuromuscular blocking agents: Succinylcholine at 33.4% Rocuronium at 29.3% Atracurium at 19.3% Vecuronium at 10.2%  Due to the quaternary ammonium ions cross-sensitivity similar to the those in cosmetics, personal products, and drugs.

10. ANTIBIOTICSLATEX  Beta-lactum Antibiotics Penicillin's Cephalosporin's  Vancomycin  Quinolones  Latex containing gloves  Catheters  Tourniquets  More common in individuals that have had multiple surgeries in the past

11.  Remove causative agent  Call for help  Intubate or maintain airway  100% FiO2  Epinephrine 1:1,000 ( α 1, α 2, β 1, β 2 )  Albuterol ( β 2 agonist)  Fluid management (0.9% NaCl or colloid- controversial)  Histamine blockers (H 1, H 2 )  Corticosteroids

12. Treatment Guide

13. Epinephrine Phenylephrine Diphenhydramine

14. Famotidine Dexamethasone Albuterol inhaler

15.  Butterworth IV, J. F., Mackey, D. C., & Wasnick, J. D. (2013). Anesthetic Complications. In Morgan & Mikhail’s Clinical Anesthesiology (5th ed. (pp. 1199-1229). New York, NY: McGraw-Hill.  Ebo, D. G., Fisher, M. M., Hagendorens, M. M., Bridts, C. H., & Stevens, W. J. (2007). Anaphylaxis during anesthesia: diagnostic approach. Allergy, 62, 471-487.  Jacobson, J., Lindekaer, A. L., Ostergaard, H. T., Nielsen, K., Ostergaard, D., Laub, M.,... Johannessen, N. (2001). Management of anaphylactic shock evaluated using a full-scale anesthesia simulator. ACTA Anaesthesiologica Scandinavica, 45, 315-319.  Mertes, P. M., Tajima, K., Regnier-Kimmoun, M. A., Lambert, M., Iohom, G., Gueant-Rodriguez, R. M., & Malinovsky, J. M. (2010, July). Perioperative Anaphylaxis. Medical Clinics of North America, 94(4).  Norred, C. L. (2012). Anesthetic-Induced Anaphylaxis. AANA Journal, 80, 129-140.  O’Donnell, M. P. (2014). The Immune System and Anesthesia. In J. J. Nagelhout, & K. L. Plaus (Eds.), Nurse Anesthesia (5th ed. (pp. 1015- 1035). St. Louis, MO: Elsevier.