Module20

Paediatrics

Anaphylaxis
Allergicreactionthatis: o Immediate o Systemic o Lifethreatening Itassociatedwithmajorchangesinthebodysuchas: o Cardiovascularsystem o Respiratorysystem o Sympatheticsystems Promptrecognitionandappropriatedrugtherapyareimportanttopt.survival o AsBLS(BAA),inourprotocolwecannottreatsevereanaphylaxis. o CALLFORBACKUP

DEFINITIONOFANAPHYLAXIS

1.1

Antigen
Antigenthatinducestheformationofantibodies Antigenscanenterthebodyby: o Injection o Ingestion o Inhalation o Absorption Examplesofcommonantigensassociatedwithanaphylacticreactions: o Drug(penicillin/aspirin) o Envenomation(beestings/waspstring) o Food(nets/seafood) o Pollen(hayfeverchangeofseasonsgenerallynotsevere) TheAntigen/substancethatcausestheallergicresponseiscalledallergen

1.2

Antibodies
Protectiveproteinsubstance o Developedbythebodyinresponsetoantigens Theybindtotheantigenthatproducedthem Theyfacilitateinneutralizingtheantigenandremovalfromthebody Thisnormalantigenantibodyreactionprotectsthebodyfromdiseasebyactivatingtheimmuneresponse Immunoglobulin=antibody

1.3

Immuneresponse
Immuneresponsesarenormallyprotective Canbecomeoversensitive Orbedirectedtowardsharmlessantigensweareexposedtooften o Whenthisoccurs Itiscalled:allergicresponse o TheAntigen/substancecausingtheallergicresponseiscalledallergen Commonallergensinclude: o Drug(penicillin/aspirin) o Envenomation(beestings/waspstring) o Food(nets/seafood) o Animals(fur) o Pollen(hayfeverchangeofseasonsgenerallynotsevere)

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Module20

Paediatrics

Healthybodyrespondstoanantigenchallengeby: o Acollectivedefencesystemknownasimmunity Immunitymaybe: o Presentatbirth,naturally o Acquired,resultingfromexposuretoaspecificantigenicagent/pathogen o Artificiallyinduced,resultingfrominoculation/immunisationsagainstinfectiousdiseasese.g. measles/diphtheria

1.4

Componentsoftheimmunesystem
Lymphaticsystem Leukocytes Lymphocytes Immunoglobulins Mediators

1.4.1

Lymphaticsystem
Everytissuesuppliedbybloodvessels(excludingthebrainandplacenta) Containlymphaticvessels Thelymphaticsystemcleanshouse Andcarriesforeignmaterialtothecorrectdisposalsitee.g.kidney

1.4.1.1 Lymphfluid
Picksup: o Organisms o cellulardebris o andorotherforeignmatterintissue andcarriesitbackthroughthelymphaticvessels includingthelymphnodes

1.4.1.2 Lymphnodes
strategicallyclumpedinareasthatmaybeexposedtolargeamountsofantigens

1.4.2

Leukocytes(whitebloodcells)
Bloodcomponentsassociatedwiththeimmuneresponse Mostleukocytesintheperipheralbloodconsistof: o Polymorphonucleargranulocytes Monocytesgobbleupantigensandchangethem Primarycellsinvolvedinphagocytosis o Neutrophils o Monocytes

1.4.3

Lymphocytes
Twoclassesoflymphocytesthatareprincipalplayersintheimmuneresponse o TLymphocytes(Tcells) T:Thymus o BLymphocytes(Bcells) B:BoneMarrow TLymphocytes(Tcells) o Makeup80%ofalllymphocytes o Producesinthethymus o Helpdefendagainstforeigncell/virusthatenterthebody

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Paediatrics

BLymphocytes(Bcells) o Accountforremaining20%oflymphocytes o Developedinbonemarrow o Equippedwithantigenswithspecificreceptors Theysplitapartandseparateinto: Specializedactiveforces(antibodies) Andreserves(memorycells)

1.4.4

ImmunoglobulinsandMediators
Immunoglobulin=antibody Mediators o Proteinsthatcausemanyphysiologicalresponses o Mostarepresentthroughoutthebodyandremaininactiveuntiltriggeredbyanimmuneresponse o Allhavedifferentproperties o Mostperformseveralfunctions

1.5

Allergicreaction
Markedbyincreasedphysiologicalresponsetoanantigenafterpreviousexposure(sensitization)tosame antigen Agentsthatmaycausehypersensitivityreactions(includinganaphylaxis) o Drugsandbiologicalagents o Insectsbitesandstrings o Foods

1.6

Anaphylaxis
Incidence Causativeagents

1.7

Histamines
Histaminescausethesymptoms Promotesvascularpermeability Causesvasodilation Causesconstrictionofnonvascularsmoothmuscle,especiallyintheGItractandthebronchitree o Thereisanassociatedincreaseingastric,nasalandlacrimal(tearductlacrimationtears) secretion,resultingintearingandrhinorrhoea Increasedcapillarypermeabilityallowsplasmatoleakintotheinterstitialspace o Profoundvasodilationcausesfurtherdecreasedcardiacpreload,thatcompromisesstrokevolume andcardiacoutput Thesephysiologicaleffectsleadto: o Sympatheticflushing o Urticarial(hives) o Angioedema(increaseinfluidoutofthecells) o Hypotension Onsetofactionisveryrapid o Effectareshortlivedbecausetheyarequicklybrokendownbytheplasmaenzymes

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Module20 1.8 Physiologyofanaphylaxis

Paediatrics

1.9

Assessmentandfindings
Respiratoryeffects(auscultate) Cardiovasculareffects(hypotension) Gastrointestinaleffects(mucousproduction) Nervoussystemeffects Sympatheticeffects(fight/flight) o Checkformedicalertbracelet o Obtainhistory o SAMPLE Diseaseentitiesthattheypresentwithsimilarsignsandsymptomsofanaphylaxis: o Severeasthmawithrespiratoryfailure o Upperairwayobstruction o Pulmonaryoedema(with/withoutMI) o Drugoverdose o Hypovolaemicshock

1.9.1

InitialassessmentABC
Airwayassessmentiscritical o Mostdeathsfromanaphylaxisdirectlyrelatedtoupperairwayobstruction Evaluatetheconsciouspt.forvoicechanges/breathingsounds o Stridor/barkingcough Complaintsof: o Tightnessintheneck o Dyspnea Bothsuggestimpendingairwayobstruction

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Paediatrics

Airwayofunconsciouspt.shouldbeevaluatedandsecured o IfairflowisobstructedCALLFORBACKUPASAP ALSshouldperformendotrachealintubation o Ifthereisseverelaryngealandepiglottisoedema ALSmyneedtoperformsurgical/needlecricothyrotomytoprovideairwayaccess MONITORPT.CLOSELYforANYsignofrespiratorydistress

1.9.2

Assessment
Assesspulse(quality,rate,location)FREQUENTLY History o Maybedifficulttoobtainbutiscriticaltoruleoutothermedicalemergenciesthatmaymimic anaphylaxis o Questionthept.regarding: Chiefcomplaint Rapidonsetofsymptoms Signsandsymptomsofanaphylaxisusuallyappearwithin130minofintroduction ofantigen(dependantofhowthebodywasintroducedtotheantigen) SAMPLE o Pt.withknownallergiesshould o Receiveinformationregardingmedicalidentificationtags/bracelets/cards o Ifpossible,contacttheirphysicianforprescriptionforepinephrine(e.g.Anakit,Epipen(pt.would usuallydothisthemselves)iftheyhaveaconditionsuchashymenopterastringanaphylaxis

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