Signs and Symptoms
Is anaphylaxis a common reaction to an allergy shot?
No
True or false - anaphylaxis can be fatal
True
A patient just received her allergy shot. She is having a systemic rash on her skin, but otherwise no symptoms. Is this anaphylaxis?
Not yet - if there is no respiratory involvement, then we are looking for 2 systems to be involved. Currently there is only one.
A patient calls the office. She received her allergy shot 1 hour ago. She is having a systemic rash on her skin, but otherwise no symptoms. What do you advise her to do?
Tell her she can take an antihistamine to help with her symptoms. She should also continue to monitor.
This does NOT warrant EpiPen use!
What system involvement are we most immediately concerned about?
Respiratory system - 3/4 of anaphylaxis victims die due to hypoxia
What is the most common time frame for anaphylaxis symptoms to appear?
within 1 hour after exposure to an allergen
A patient comes in feeling well. You give him his allergy shot. Within 15 minutes he has hives all over his arms and he says he might vomit. You check his pulse and notice it is racing. Is this anaphylaxis?
Most likely! There are two systems involved and signs and symptoms align with anaphylaxis. Consult with Dr. Rao or Shelby for further assessment.
A patient calls the office. She received her allergy shot 1 hour ago. She is having significant trouble breathing. What do you advise her to do?
Use her EpiPen IMMEDIATELY - then call 911.
What causes red skin with anaphylaxis?
What is the most important thing to do immediately after administering epinephrine to a patient?
Call 911
You are observing an allergy test. A patient starts turning white and says they feel faint. You check their pulse and it is slow. Is this anaphylaxis?
No - patients will turn RED with anaphylaxis, due to vasodilation. They will also have a FAST heart rate, as the body tries to compensate for the vasodilation.
A patient received his allergy shot a few minutes ago. Now, you are rooming the patient to see Shelby. Suddenly they are having significant trouble breathing. What should you do?
Stay with the patient
Yell for help
Let Dr. Rao or Shelby evaluate for anaphylaxis
What causes a high heart rate with anaphylaxis?
Vasodilation - causes low blood pressure, and the heart tries to compensate by beating faster
What does biphasic mean in the context of anaphylaxis?
2 separate reaction windows - even if the first anaphylactic event clears up, a second event may occur hours later
A patient calls the office. He said he administered sublingual immunotherapy 45 minutes ago. Shortly after he noticed he was wheezing and having trouble breathing. He self administered his EpiPen. He knows he is supposed to call 911, but he is worried about the cost. He wants to know if his wife can just drive him to the hospital? Why or why not?
No - it is STRONGLY advised he takes an ambulance. Epinephrine is short acting only, and he many need supportive care while enroute.
Dr. Rao determines that a patient is having anaphylaxis. He administers one EpiPen. The patient immediately feels better. In fact, they say they are back to normal and ask if we can just monitor them here. What do you say?
No - we MUST IMMEDIATELY send them to the hospital. It is possible they could have a a biphasic reaction later, therefore ongoing monitoring is crucial.
What are the key differences between vasovagal events and anaphylaxis?
Anaphylaxis - red, warm, dry skin; high heart rate, low blood pressure
Vasovagal - pale skin, cold sweats, low heart rate, normal blood pressure
What 3 chemical mediators cause bronchoconstriction?
Prostaglandin D, Leukotrienes, and platelet activation factor
A patient received his allergy shot a few minutes ago. Now, you are rooming the patient to see Shelby. Suddenly they start having symptoms of anaphylaxis. What might these symptoms be? List at least 3
- airway involvement - trouble breathing, tight throat, wheezing
-2 other systems involved - systemic skin rash, GI symptoms (nausea or vomiting), feeling of impending doom
-red skin, fast heart rate, low blood pressure
You are taking patient history while rooming for Dr. Rao. A patient mentions that they are taking a medication ending in "-alol". You look it up and it is a beta blocker. They also mention sublingual immunotherapy is going well. What should you do?
Tell Dr. Rao when giving report - patients cannot be on Beta blockers because it directly inhibits epinephrine efficacy.