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ARTICLES IN THE BOOK

  1. Acute abdomen
  2. Acute coronary syndrome
  3. Acute pancreatitis
  4. Acute renal failure
  5. Agonal respiration
  6. Air embolism
  7. Ambulance
  8. Amnesic shellfish poisoning
  9. Anaphylaxis
  10. Angioedema
  11. Aortic dissection
  12. Appendicitis
  13. Artificial respiration
  14. Asphyxia
  15. Asystole
  16. Autonomic dysreflexia
  17. Bacterial meningitis
  18. Barotrauma
  19. Blast injury
  20. Bleeding
  21. Bowel obstruction
  22. Burn
  23. Carbon monoxide poisoning
  24. Cardiac arrest
  25. Cardiac arrhythmia
  26. Cardiac tamponade
  27. Cardiogenic shock
  28. Cardiopulmonary arrest
  29. Cardiopulmonary resuscitation
  30. Catamenial pneumothorax
  31. Cerebral hemorrhage
  32. Chemical burn
  33. Choking
  34. Chronic pancreatitis
  35. Cincinnati Stroke Scale
  36. Clinical depression
  37. Cord prolapse
  38. Decompression sickness
  39. Dental emergency
  40. Diabetic coma
  41. Diabetic ketoacidosis
  42. Distributive shock
  43. Drowning
  44. Drug overdose
  45. Eclampsia
  46. Ectopic pregnancy
  47. Electric shock
  48. Emergency medical services
  49. Emergency medical technician
  50. Emergency medicine
  51. Emergency room
  52. Emergency telephone number
  53. Epiglottitis
  54. Epilepsia partialis continua
  55. Frostbite
  56. Gastrointestinal perforation
  57. Gynecologic hemorrhage
  58. Heat syncope
  59. HELLP syndrome
  60. Hereditary pancreatitis
  61. Hospital
  62. Hydrocephalus
  63. Hypercapnia
  64. Hyperemesis gravidarum
  65. Hyperkalemia
  66. Hypertensive emergency
  67. Hyperthermia
  68. Hypoglycemia
  69. Hypothermia
  70. Hypovolemia
  71. Internal bleeding
  72. Ketoacidosis
  73. Lactic acidosis
  74. Lethal dose
  75. List of medical emergencies
  76. Malaria
  77. Malignant hypertension
  78. Medical emergency
  79. Meningitis
  80. Neuroglycopenia
  81. Neuroleptic malignant syndrome
  82. Nonketotic hyperosmolar coma
  83. Obstetrical hemorrhage
  84. Outdoor Emergency Care
  85. Overwhelming post-splenectomy infection
  86. Paralytic shellfish poisoning
  87. Paramedic
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  90. Physical trauma
  91. Placenta accreta
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  96. Psychotic depression
  97. Respiratory arrest
  98. Respiratory failure
  99. Retinal detachment
  100. Revised Trauma Score
  101. Sepsis
  102. Septic arthritis
  103. Septic shock
  104. Sexual assault
  105. Shock
  106. Simple triage and rapid treatment
  107. Soy allergy
  108. Spinal cord compression
  109. Status epilepticus
  110. Stroke
  111. Temporal arteritis
  112. Testicular torsion
  113. Toxic epidermal necrolysis
  114. Toxidrome
  115. Triage
  116. Triage tag
  117. Upper gastrointestinal bleeding
  118. Uterine rupture
  119. Ventricular fibrillation
  120. Walking wounded
  121. Watershed stroke
  122. Wilderness first aid
  123. Wound
 



THE BOOK OF MEDICAL EMERGENCIES
This article is from:
http://en.wikipedia.org/wiki/Anaphylaxis

All text is available under the terms of the GNU Free Documentation License: http://en.wikipedia.org/wiki/Wikipedia:Text_of_the_GNU_Free_Documentation_License 

Anaphylaxis

From Wikipedia, the free encyclopedia

 

In medicine, anaphylaxis is a severe and rapid multi-system allergic reaction. Anaphylaxis occurs when a person is exposed to a trigger substance, called an allergen, to which they have already become sensitized. Minute amounts of allergens may cause a life-threatening anaphylactic reaction. Anaphylaxis may occur after ingestion, inhalation, skin contact or injection of an allergen. The most severe type of anaphylaxis—anaphylactic shock—will usually lead to death in minutes if left untreated.

The word is from New Latin (derived from Greek ἀνα-/ana, meaning "up, again, back, against") + φύλαξις/phylaxis, meaning "guarding, protection"—cf. prophylaxis).

Researchers typically distinguish between "true anaphylaxis" and "pseudo-anaphylaxis." The symptoms, treatment, and risk of death are identical, but "true" anaphylaxis is always caused directly by IgE-mediated degranulation of mast cells or basophils, and pseudoanaphylaxis is caused by any and all other means. The distinction is only important for researchers who are studying mechanisms of allergic reactions, and it often frustrates patients who feel they are being told that a life-threatening allergic reaction wasn't "real."


 

Emergency treatment

Anaphylactic shock, the most serious of allergic reactions, is a life-threatening medical emergency because of rapid constriction of the airway, often within minutes of onset. Calling for help immediately is important, as brain and organ damage rapidly occurs if the patient cannot breathe. Anaphylactic shock requires immediate advanced medical care; but other first aid measures include rescue breathing (part of CPR) and administration of epinephrine (adrenaline). Rescue breathing may be hindered by the constricted airways but is essential if the victim stops breathing on their own. If the patient has previously been diagnosed with anaphylaxis, they may be carrying an EpiPen (or similar device) for immediate administration of epinephrine (adrenaline) by a layperson to help keep the airway open. Use of an EpiPen or similar device will only provide temporary and limited relief of symptoms, so emergency medical services must still be contacted. Repetitive administration of epinephrine can cause tachycardia (rapid heartbeat) and occasionally ventricular tachycardia with heart rates potentially reaching 240 beats per minute, which can also be fatal. Extra doses of epinephrine can sometimes cause cardiac arrest. This is why some protocols advise intramuscular injection of only 0.3–0.5mL of a 1:1,000 dilution. The epinephrine will prevent worsening of the airway constriction, stimulate the heart to continue beating, and may be life-saving.

Epinephrine will act on Beta-2 adrenergic receptors in the lung as a powerful bronchodilator relieving allergic or histamine-induced acute asthmatic attack or anaphylaxis. Tachycardia results from stimulation of Beta-1 adrenergic receptors of the heart increasing contractility (inotropic effect) and frequency (chronotropic effect) and thus cardiac output.

Every patient prone to anaphylaxis should have an "allergy action plan" on file at school, home or in their office to aid family members, teacher and/or co-workers in case of an anaphylactic emergency. The Asthma and Allergy Foundation of America provides a free "plan" form anyone can print from their site. Action plans are considered essential to quality emergency care.

Symptoms

Symptoms of anaphylaxis are related to the action of immunoglobulin E (IgE) and other anaphylatoxins, which act to release histamine and other mediator substances from mast cells (degranulation). In addition to other effects, histamine induces vasodilation of arterioles and constriction of bronchioles in the lungs, also known as bronchospasm (constriction of the airways).

Symptoms can include the following:

  • respiratory distress,
  • hypotension (low blood pressure),
  • fainting,
  • unconsciousness,
  • urticaria (hives),
  • flushed appearance,
  • angioedema (swelling of the face, neck and throat),
  • tears (due to angioedema and stress),
  • vomiting,
  • itching, and
  • anxiety

The time between ingestion of the allergen and anaphylaxis symptoms can vary for some patients depending on the amount of allergen ingested and sensitivity. Symptoms can appear immediately, or can be delayed by half an hour to several hours after ingestion. However, symptoms of anaphylaxis usually appear very quickly once they do begin.

Causes

Peanuts are a common trigger of anaphylactic reactions.
Peanuts are a common trigger of anaphylactic reactions.

Common causative agents in humans include:

  • foods (e.g. milk, cheese, nuts, peanuts, soybeans and other legumes, fish and shellfish, wheat, fruit, and eggs);
  • drugs (e.g. penicillins and cephalosporins, contrast media, ASA and other NSAIDs such as ibuprofen and diclofenac);
  • latex;
  • Hymenoptera stings from insects such as bees, wasps, yellowjackets, hornets, and some stinging ants; and
  • exercise (see exercise-induced anaphylaxis).

Transfusion of incompatible blood products may lead to extremely similar symptoms, albeit for substantially different biochemical reasons.

Passive transfer

The anaphylactic reaction is mediated by antibodies. Anaphylactic sensitivity can be transferred to a normal (non-sensitive) recipient by means of serum containing such antibodies. This is then called passive transfer of the allergy or hypersensitivity.

The source of antibody may be from the same species, e.g. the human species, for which the predominant immunoglobulin involved is of the IgE class. Some known cases of deaths resulting from passive transfer involve organ transplants. It may also be transferred from animals of a different species. For example, a guinea pig may be sensitized by an intravenous injection of rabbit antibody to ovalbumin. When challenged (that is, brought in contact) with ovalbumin 48 hours later, the guinea pig will suffer fatal anaphylactic shock.

Treatment

Paramedic treatment in the field may include injection with epinephrine, administration of oxygen therapy and, if necessary, intubation during transport to advanced medical care. In profuse angioedema, cricothyrotomy or tracheotomy may be required to maintain oxygenation.

The clinical treatment of anaphylaxis by a doctor and in the hospital setting aims to treat the cellular hypersensitivity reaction as well as the symptoms. Antihistamine drugs (which inhibit the effects of histamine at histamine receptors) are given but are usually not sufficient in anaphylaxis, and high doses of intravenous corticosteroids are often required. Hypotension is treated with intravenous fluids and sometimes vasoconstrictor drugs. For bronchospasm, bronchodilator drugs (e.g. Salbutamol, known as Albuterol in the United States) are used. In severe cases, immediate treatment with epinephrine can be lifesaving. Supportive care with mechanical ventilation may be required.

Patients must be monitored for four hours after being transported to medical care for the possibility of biphasic reactions (recurrence of anaphylaxis) [1].

Exercise-induced anaphylaxis shock occurs when a sufferer has eaten a food to which they are allergic to, followed by a high heart rate actively like jogging. This may be avoided by exercising on an empty stomach, drinking coffee for its caffeine, and taking vitamin C.

See also

  • Atopic syndrome
  • Hypersensitivity
  • Food allergy

References

  • Krause, RS. 2005. Anaphylaxis. Emedicine.com.
  • Howland, R. 2006. Lippincott's Review of Pharmacology, 3rd Edition
  • Gomella, LG. 2005. Clinician's Pocket Drug Reference. Drug Manual.
Retrieved from "http://en.wikipedia.org/wiki/Anaphylaxis"

 

 

 


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