Anaphylaxis
Respiratory Distress
Abdominal symptoms
Skin and mucosal symptoms
Hypotension
What is the RASH criteria?
Airway oedema
Mucous hypersecretion
Bronchoconstriction
What are the 3 elements required for an asthma presentation?
What does COPD stand for?
Chronic Obstructive Pulmonary Disease
What cm H20 is required for CPAP in COPD?
7.5
Arrhythmia, palpitations, hypertension and angina
What are the cardiovascular adverse effects of Adrenaline?
IgE
Mast cells
What immunoglobulin triggers anaphylaxis? And what does it bind to?
What do anaphylaxis and asthma share?
IgE sensitisation process
What are the two sub-categories of COPD?
Chronic bronchitis
Emphysema
What is the management of severe asthma, including dosage?
-Salbutamol 5mg nebulised at 20 minute intervals
-Ipatropium Bromide 500mcg nebulised (once only)
-Dexamethasone 8mg IV/IM/Oral
-Request MICA
Known pancreatic tumours
Known phaechromocytoma (tumour of the adrenal gland)
What are the contraindications for glucagon?
What is the definition for anaphylaxis?
A severe life-threatening generalised or systemic hypersensitivity reaction
Which phase of the expiratory cycle will you expect to hear a wheeze in asthma?
Expiratory phase
What are the two causes of COPD and what do they cause?
Genetic suseptability -> decreased ability for the lungs to prevent damage to the lung tissue
Environmental insult to lungs -> Free radicles produced in lungs amd inactivation of lung anti-proteases
What do all COPD exacerbations receive, including dosage?
-Salbutamol 4-12 PMDI (preferred)
-Ipatropium Bromide 500mcg AND nebulised salbutamol 5mg
-O2 target to 88-92%
-Dexamethasone, 8mg (IV/IM/Oral)
Synthetic corticosteroid which
1. Supresses immune system
2. Immunosupression
What is the Mechanism of Action of Dexamethasone?
What are 3 treatable signs or symptoms of anaphylaxis? (as per AV CPG)
Airway oedema/Stridor
Bronchospasm
Cardiovascular (Hypotension)
Which subcategory of shock causes a cardiac arrest in asthma?
Obstructive Shock
What are 3 manifestations of COPD? (need 3 for points :) )
Lung inflammation
Air trapping
Mucus trapping
Airway narrowing
Bullae
What is the priority intervention for anaphylaxis and why? (Adrenaline's MoA)
IM Adrenaline (500mcg repeated @5 minute intervals)
-Alpha 1 agonist --> vasoconstriction to combat shock
-Beta 1 agonist--> contractility, ionotropy, dromotropy
-Beta 2 agonist --> bronchodilation
-Mast cell stabiliser
List all five of the adverse effects of Ipatropium Bromide?
Palpitations, tachycardia, nausea, dizziness and headache
What are the 5 most common categories triggering anaphylaxis?
Food
Insect stings
Medications
Exercise induced
Idiopathic
Which 3 inflammatory mediators are responsible for asthma presentation? And what does each result in?
Leukotrines -> bronchoconstriction
Platelet aggregating factor -> mucous hypersecretions
Histamines -> vasodilation and vascular hyperpermeability
Explain the CO2 retention process?
CO2 retention causes levels to be elevated consistently and therefore the central chemoreceptors become insensitive to CO2 changes. Therefore, relying on peripheral chemoreceptors which detect changes to oxygen only and oxygen need to be below 60 mmHg which is equivalent to an Sp02 of 88-92%
Why do we give glucagon in anaphylaxis that remains unresponsive to adrenaline?
Bypasses the adrenergic B receptors (beta blockers or HF) to increase contractility and HR through independent glucagon receptors.
What can large doses of Salbutamol cause?
1. Hypokalaemia
2. Hyperglycaemia
3. Metabolic acidosis