Dr. Stella Yiu Emergency Physician, TOH

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Presentation transcript:

Dr. Stella Yiu Emergency Physician, TOH Anaphylaxis Dr. Stella Yiu Emergency Physician, TOH

LMCC Objectives History and Physical of allergic reaction pts Determine urticaria with systemic diseases Investigations to identify allergens Manage urticaria and anaphylaxis in ED

1. History and Physical

CDMQ: What can cause allergic reactions? (5 categories)

Urticaria: triggers Photo credit: ambert, cwulmer, Norm & Debra, FlickR creative commons

Drugs Food allergens Insects Physical stressors (cold, exercise) Respiratory allergy (Pollen)

What systems are involved?

Blood vessels Photo credit: kiwinky, Flickr commons

Lungs

GI tract

Soft tissues © anaphylaxisweb

50% has angioedema (lips/face/upper airway)

If airway/tongue -> potential airway obstruction

Investigations for allergic reaction/anaphylaxis No Labs Maybe skin testing later

2. Acute/chronic + systemic illness

Urticaria Photo credit: kiwinky, Flickr commons

Systemic illness -> urticaria Serum sickness Transfusion reactions Viral/bacterial infections Vasculitis

Systemic illness: serum sickness Photo credit: mrmason.ca

Systemic illness: serum sickness Fever, rash, arthralgia Photo credit: mrmason.ca

Systemic illness: transfusion reactions

Systemic illness: transfusion reactions

Systemic illness: transfusion reactions

Systemic urticaria: Viral/Bacterial infection Photo credit: Dermatolog Information System

Systemic urticaria: Vasculitis Associated with SLE, Sjogren, Leukemia Drugs Systemic unwell: Arthralgia, fever, abdo pain, lymphadenopathy Photo credit: Dermatology image atlas

Definition of anaphylaxis

MCQ 5: Who does not have anaphylaxis? Ate peanut butter. Swollen lips and wheezing. VS normal. Shrimp fest at Red Lobsters. Vomiting and tight throat. Stung by bee. Low BP. Flu shot. Hives. VS normal. Hay fever, swollen throat, low BP.

Anaphylaxis Definition > 2 systems: CVS (BP), airway, GI, skin Skin + airway/BP BP

3. Manage anaphylaxis

CDMQ: Management steps of patient with anaphylaxis (8)

Airway (2): Epinephrine im Intubate if needed (what indications)

Breathing (1): Oxygen B2 agonist (Ventolin)

Bronchodilators Epinephrine

Circulation (2) Iv fluids if hypotensive Iv epinephrine if no better

Fluids

Drugs (3) Antihistamines (H1- Benadryl, H2- Ranitidine) Steroids

Antihistamines H1: Benadryl (Diphenhydramine) H2: Ranitidine

Fluids, Symptomatic

Discharge instructions Allergy testing outpatient Carry Epi-Pen at all times Photo credit: gregfriese, flickr creative commons

Discharge meds Steroid -  2nd phase reaction (6-72 hours) - Prednisone po or solumedrol iv Continue Antihistamines

LMCC Objectives History and Physical of allergic reaction pts Determine urticaria with systemic diseases Investigations to identify allergens Manage urticaria and anaphylaxis in ED