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Module 4: Allergic Reaction

Allergic Reaction Objectives


 The student will understand the
pathophysiology of Allergic Reactions
Module 4: Medical/Behavioral Emergencies
 The student will recognize and
Institute for Emergency Medical Education appropriately treat allergic reactions

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Anatomy & Physiology of the


Overview
Immune System
 Definitions
 A & P of the Immune – Allergic Reaction - response of the body’s
System immune system when challenged by a
 Pathophysiology of foreign substance
allergic reaction – Anaphylactic Reaction - a severe allergic
 Assessment and reaction in which the bodies response
causes a life threatening condition
Interventions
– Antigen - foreign material that enters the
body

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Anatomy & Physiology of the Anatomy & Physiology of the


Immune System Immune System
 Definitions  Definitions
– Antibodies - protective proteins that – Made up of the liver, spleen, bone marrow,
circulate throughout the body white blood cells (5 types) and antibodies
– Uticaria - medical term for allergy induced – The body produces a specific antibody for
rash every antigen that it comes in contact with
 Immune System – The antibodies are produced by
– Purpose is to protect the body from any lymphocytes (1 type of WBC)
and all foreign materials

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Module 4: Allergic Reaction

Anatomy & Physiology of the Types of Allergic or Immune


Immune System Reactions
 Definitions  Type 1 or Immediate Hypersensitivity
– When the antibody encounters it’s antigen, – Most common type that requires transport
it binds to or covers it, which in turn
stimulates WBC to destroy it – Most common antigens causing this
reaction
– Other WBC stimulated to release
• Insect venom
Histamine,
• Antibiotics
– Histamine
• causes tissue edema, bronchiole constriction • Nuts, Shell fish and strawberries
and other effects

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Pathophysiology Pathophysiology
 White Blood Cells release histamine which is a  Histamine is also a bronchoconstrictor which
potent vasodilator which can cause the blood can cause wheezing and difficulties breathing
vessels to leak causing edema  Histamine release can also cause itchy/watery
 The vasodilatation within the skin causes eyes and runny nose
redness and a rash (hives) or Uticaria  General vasodilitation may cause hypotension
 If tissue swelling occurs in the upper airways, it and shock
can cause an airway obstruction and respiratory  The most extreme example of this reaction is
distress (causing Stridor) Anaphylaxis

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Types of Allergic or Immune Initial Assessment


Reactions  Assessment  Intervention
– General Impression/AVPU
 Local Reaction or Type II – Call for ALS
– Airway
– mechanism remains unchanged but the • Complaints of difficulty
swallowing, swelling in lips, – Open, clear and insert
histamine release and it’s associated mouth, throat, or tongue are
serious adjunct
symptoms stay in the immediate area of
– Breathing – High Flow Oxygen,
the exposure • Oxygen Saturation Ventilate if needed
• Check upper airways for
Stridor, crowing sounds or – Treat for Shock
high pitched whistling sounds
– Circulation
– Vital Signs
• Monitor for signs of shock

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Module 4: Allergic Reaction

Remember! Peal of Wisdom


 Initial Assessment  By latex allergies is  When assessing a
patient, if they state
– 75% of the patients who die from not a primary they are having an
anaphylaxis die from respiratory problems, concern to EMS allergic reaction, but
the remaining 25% die from shock providers since all have no observable
our equipment is signs or complaints of
– Therefore, the initial assessment should dyspnea or difficulty
ensure that the airway is patent and that now required to be swallowing, consider
breathing and circulation is adequate latex free going to the focused
performing appropriate initial interventions – Note the allergy and assessment prior to
if appropriate initiating oxygen
document it
therapy

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Rapid/Focused History & Rapid/Focused History &


Physical Exam Physical Exam
 Assessment  Intervention  Assessment (continued)
– Check skin for hives – Place patient on
(uticaria), swelling, – Substance in which the patient was exposed
redness Oxygen (if not
– Mode of exposure (ingestion, injection, etc.)
– Patient may complain of already done in the
ABD cramps, vomiting or initial) – Symptoms/effects
itchiness – Progression of effects and time period (the
– Does the patient have a
prescription for – Administer more rapid the progression the more serious)
epinephrine? Epinephrine auto- • Any interventions performed (antihistamines or
– Take a SAMPLE History injector epinephrine already taken)
– History of allergies or
allergic reactions

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Focused History: Intervention -Rapid/Focused


Don’t forget SAMPLE/OPQRST History
 S = signs (findings)  O = Onset of symptoms – Goal: reducing further histamine release and
and/or symptoms (when did it start?) managing those problems that are already
 P = provocation (what makes present
 A = allergies it worse?)
 M = medications  Q = quality – Drug Therapy
 P = past medical history  R = radiation • Antihistamines are used for mild reactions but are
 L = last oral intake  S = severity not currently authorized for EMT-Basics
 E = Event, what – Have patient rate pain on 1– • In severe cases of allergic reactions
10 scale
happened to the patient (anaphylaxis), epinephrine (adrenaline) is
 T = time (how long does it indicated and may be life saving
last?)

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Module 4: Allergic Reaction

State Wide Treatment Protocol:


Detailed & On Going Asses. ALLERGIC REACTION / ANAPHYLAXIS 3.2
Amended 8/5/04

 Detailed Exam  On Going Assessment  ASSESSMENT / TREATMENT


– Assess for more – Reassess findings of the
subtle signs or initial assessment & vital PRIORITIES
changes in patient signs – Determine if patient is in mild or severe distress:
condition – Remember to reassess • Mild Distress: itching, isolated urticaria, nausea, no
vital signs
– Perform an in-depth respiratory distress.
• Stable: 15 minutes
SAMPLE history • Severe Distress: stridor, bronchospasm, severe
• Unstable: 5 minutes
– Remember that the abdominal pain, respiratory distress, tachycardia,
– Assess interventions for
patient may suddenly shock (systolic BLOOD PRESSURE <90), observe for
effectiveness
progress quickly, so edema of lips, tongue or face and generalized
be alert for changes urticaria. Monitor and record ECG and vital signs.

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State Wide Treatment Protocol:


ALLERGIC REACTION / ANAPHYLAXIS 3.2 Amended 8/5/04
Medication Name & Class
 BASIC PROCEDURES – BLS STANDING ORDERS
• If patient presents in Severe Distress, as
– Ensure scene safety and maintain
appropriate body substance isolation
defined in Assessment Priorities, and if
patient age is between 5 and 65 years:  Epinephrine auto-  Generic Name
precautions. administer epinephrine by auto-injection.
• A second injection may be administered, if
injector (Epi-Pen, Ana- – Epinephrine
– Maintain an open airway. This may available, in 5 minutes if necessary. NOTE: Kit)
include repositioning of the airway, Adult EPI-PENs® should be used on
suctioning, or use of airway adjuncts patients greater than 30 kg (66 lbs).
Pediatric EPI-PENs® (EPI-PEN JR. ®)
 Class
(oropharyngeal airway/ should be used on patients less than 30 kg – Natural occurring  Trade Name
nasopharyngeal airway) as indicated. (66 lbs). NOTE: EMTs must contact
Assist ventilations as needed. Medical Control prior to administration of Catacolamine within the – Adrenaline
epinephrine by auto-injector when patient is
– Administer oxygen using appropriate under age 5 or over age 65. body and is a potent
oxygen delivery device, as clinically – If patient’s BLOOD PRESSURE drops vasoconstrictor and
indicated. bronchodilator that
below 100 systolic: treat for shock.
– Activate ALS intercept, if deemed – Monitor and record vital signs every 5 counteracts the effects of
necessary and if available. minutes at a minimum if unstable, or histamine
– Initiate transport as soon as possible every 15 minutes if stable.
with or without ALS.

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Contraindications / Forms
Indications
 Must meet all of the following three  No contraindications when used in a life
criteria threatening situation
– Emergency medical care for the treatment
of the patient exhibiting the assessment
findings of an allergic reaction  Medication form - liquid administered
– Medication is prescribed for this patient by via an automatically injectable needle
a physician and syringe system
– Medical direction authorizes use for this
patient

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Module 4: Allergic Reaction

Actions / Dosage/ Side Effects Administration


 Actions  Side Effects  Obtain order from medical direction either on-
– Dilates the bronchiole – Increases heart rate line or off-line
– Constricts blood vessels – Pallor
 Obtain patient's prescribed auto injector.
 Dosage – Dizziness
– Adult- one adult auto- – Chest pain  Ensure
injector (0.3 mg) – Prescription is written for the patient experiencing
– Headache
– Infant and child - one the allergic reactions
infant/child auto-injector – Nausea
(0.15 mg) – Vomiting – Medication is not discolored
– Excitability,  Remove safety cap from the auto-injector
anxiousness

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Administration Re-assessment strategies


 Place tip of auto-injector against patient's thigh  Continue focused assessment of
– Lateral portion of the thigh, midway between the waist airway, breathing and circulatory status
and the knee
 Patient condition continues to worsen
 Push the injector firmly against the thigh to
activate the injector – Decreasing mental status
 Hold the injector in place until the medication is – Increasing breathing difficulty
injected – Decreasing blood pressure
 Record activity and time & Dispose of injector in  Obtain medical direction
biohazard container – Additional dose of epinephrine

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Re-assessment strategies Summary


 It is important to treat all allergic reactions
 Treat for shock (hypoperfusion) aggressively
 Prepare to initiate Basic Cardiac Life  Any patient experiencing difficulty
Support measures swallowing or other evidence of airway
– CPR/AED swelling is experiencing anaphylaxis
 Document all responses to medications  In cases of anaphylaxis, epinephrine is
extremely beneficial in improving the
patients outcome

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Module 4: Allergic Reaction

Questions?

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