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Project: Ghana Emergency Medicine Collaborative Document Title: Anaphylaxis Author(s): Peter Moyer (Boston University), MD, MPH 2012 License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/ We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. These lectures have been modified in the process of making a publicly shareable version. The citation key on the following slide provides information about how you may share and adapt this material. Copyright holders of content included in this material should contact [email protected] with any questions, corrections, or clarification regarding the use of content. For more information about how to cite these materials visit http://open.umich.edu/privacy-and-terms-use. Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition. Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers. 1

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Page 1: Project: Ghana Emergency Medicine Collaborative Document Title: Anaphylaxis Author(s): Peter Moyer (Boston University), MD, MPH 2012 License: Unless otherwise

Project: Ghana Emergency Medicine Collaborative

Document Title: Anaphylaxis

Author(s): Peter Moyer (Boston University), MD, MPH 2012

License: Unless otherwise noted, this material is made available under the terms of the Creative Commons Attribution Share Alike-3.0 License: http://creativecommons.org/licenses/by-sa/3.0/

We have reviewed this material in accordance with U.S. Copyright Law and have tried to maximize your ability to use, share, and adapt it. These lectures have been modified in the process of making a publicly shareable version. The citation key on the following slide provides information about how you may share and adapt this material.

Copyright holders of content included in this material should contact [email protected] with any questions, corrections, or clarification regarding the use of content.

For more information about how to cite these materials visit http://open.umich.edu/privacy-and-terms-use.

Any medical information in this material is intended to inform and educate and is not a tool for self-diagnosis or a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional. Please speak to your physician if you have questions about your medical condition.

Viewer discretion is advised: Some medical content is graphic and may not be suitable for all viewers.

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Page 2: Project: Ghana Emergency Medicine Collaborative Document Title: Anaphylaxis Author(s): Peter Moyer (Boston University), MD, MPH 2012 License: Unless otherwise

Attribution Key

for more information see: http://open.umich.edu/wiki/AttributionPolicy

Use + Share + Adapt

Make Your Own Assessment

Creative Commons – Attribution License

Creative Commons – Attribution Share Alike License

Creative Commons – Attribution Noncommercial License

Creative Commons – Attribution Noncommercial Share Alike License

GNU – Free Documentation License

Creative Commons – Zero Waiver

Public Domain – Ineligible: Works that are ineligible for copyright protection in the U.S. (17 USC § 102(b)) *laws in your jurisdiction may differ

Public Domain – Expired: Works that are no longer protected due to an expired copyright term.

Public Domain – Government: Works that are produced by the U.S. Government. (17 USC § 105)

Public Domain – Self Dedicated: Works that a copyright holder has dedicated to the public domain.

Fair Use: Use of works that is determined to be Fair consistent with the U.S. Copyright Act. (17 USC § 107) *laws in your jurisdiction may differ

Our determination DOES NOT mean that all uses of this 3rd-party content are Fair Uses and we DO NOT guarantee that your use of the content is Fair.

To use this content you should do your own independent analysis to determine whether or not your use will be Fair.

{ Content the copyright holder, author, or law permits you to use, share and adapt. }

{ Content Open.Michigan believes can be used, shared, and adapted because it is ineligible for copyright. }

{ Content Open.Michigan has used under a Fair Use determination. }

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Page 3: Project: Ghana Emergency Medicine Collaborative Document Title: Anaphylaxis Author(s): Peter Moyer (Boston University), MD, MPH 2012 License: Unless otherwise

Definition

• A rapid onset allergic reaction which may be life threatening

• True emergency – requires immediate diagnosis and Rx

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Page 4: Project: Ghana Emergency Medicine Collaborative Document Title: Anaphylaxis Author(s): Peter Moyer (Boston University), MD, MPH 2012 License: Unless otherwise

Terminology

• Anaphylaxis - IgE mediated after previous exposure

• Anaphylactoid - not IgE but immune complex complement mediated; no prior exposure required

• Therapeutically identical

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Page 5: Project: Ghana Emergency Medicine Collaborative Document Title: Anaphylaxis Author(s): Peter Moyer (Boston University), MD, MPH 2012 License: Unless otherwise

Common Causes

• Drugs b lactam antibiotics: penicillins and

cephalosporins aspirin and other NSAIDs sulfa drugs aminoglycosides

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Page 6: Project: Ghana Emergency Medicine Collaborative Document Title: Anaphylaxis Author(s): Peter Moyer (Boston University), MD, MPH 2012 License: Unless otherwise

Common Causes

• Foods and additives – more common in children shellfish nuts milk eggs sulfites wheat soybeans

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Page 7: Project: Ghana Emergency Medicine Collaborative Document Title: Anaphylaxis Author(s): Peter Moyer (Boston University), MD, MPH 2012 License: Unless otherwise

Common Causes

• Stings• Vaccines• Latex• X-Ray contrast material

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Page 8: Project: Ghana Emergency Medicine Collaborative Document Title: Anaphylaxis Author(s): Peter Moyer (Boston University), MD, MPH 2012 License: Unless otherwise

Pathophysiology

• Release of vasoactive and bronchial mediators from mast cells and basophils (histamines, prostaglandins, leukotrienes, etc.)

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Page 9: Project: Ghana Emergency Medicine Collaborative Document Title: Anaphylaxis Author(s): Peter Moyer (Boston University), MD, MPH 2012 License: Unless otherwise

Clinical Picture• 2 or more of following:

skin pruritus urticaria

respiratory upper airway lump in throat hoarseness stridor

lower airway bronchoconstriction

wheezing

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Page 10: Project: Ghana Emergency Medicine Collaborative Document Title: Anaphylaxis Author(s): Peter Moyer (Boston University), MD, MPH 2012 License: Unless otherwise

Clinical Picture

• Hypotension - distributive shock

• GI - cramps and vomiting

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Page 11: Project: Ghana Emergency Medicine Collaborative Document Title: Anaphylaxis Author(s): Peter Moyer (Boston University), MD, MPH 2012 License: Unless otherwise

Clinical Picture

• Rapid onset - minutes to hours, most within 1 hour

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Page 12: Project: Ghana Emergency Medicine Collaborative Document Title: Anaphylaxis Author(s): Peter Moyer (Boston University), MD, MPH 2012 License: Unless otherwise

Recurrence

• Up to 20% recur within 8 hours

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Page 13: Project: Ghana Emergency Medicine Collaborative Document Title: Anaphylaxis Author(s): Peter Moyer (Boston University), MD, MPH 2012 License: Unless otherwise

Treatment

• 1st line: • Epinephrine - has both alpha and beta-2 effects - reduces mucosal edema, reduces

capillary leakage, vasoconstricts, bronchodilates

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Page 14: Project: Ghana Emergency Medicine Collaborative Document Title: Anaphylaxis Author(s): Peter Moyer (Boston University), MD, MPH 2012 License: Unless otherwise

Treatment

• Epinephrine dosing and administrationo 0.3 (kids) to 0.5 mg (adults); (0.3-0.5ml of 1:1000) IM

in thigho Repeat q 5 min as necessary o Epinephrine auto injector (Epipen) is easiest

and safest (comes in 0.3 and 0.5 mg dosages)

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Page 15: Project: Ghana Emergency Medicine Collaborative Document Title: Anaphylaxis Author(s): Peter Moyer (Boston University), MD, MPH 2012 License: Unless otherwise

Treatment

• Epinephrine – if refractory to IM Rx or cardiovascular collapse – 0.1 mg IV epi over 5-10 minutes (0.1 mg of the 1:10,000)

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Page 16: Project: Ghana Emergency Medicine Collaborative Document Title: Anaphylaxis Author(s): Peter Moyer (Boston University), MD, MPH 2012 License: Unless otherwise

Treatment

• Shock – IV fluids wide open

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Page 17: Project: Ghana Emergency Medicine Collaborative Document Title: Anaphylaxis Author(s): Peter Moyer (Boston University), MD, MPH 2012 License: Unless otherwise

Treatment

• IV steroids and antihistamines (H1 and H2 blockers) to prevent recurrence

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Page 18: Project: Ghana Emergency Medicine Collaborative Document Title: Anaphylaxis Author(s): Peter Moyer (Boston University), MD, MPH 2012 License: Unless otherwise

Observation

• Admit or observe for 8 hours to watch for recurrence

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