Unit 2 Working under pressure.

Investigate and write all about Anaphylactic shock, symptoms and

signs, treatment. 

Diagnosis

Your doctor will ask you questions about previous allergic reactions,
including whether you've reacted to:

 Particular foods
 Medications
 Latex
 Insect stings

To help confirm the diagnosis:

 You might be given a blood test to measure the amount of a certain

enzyme (tryptase) that can be elevated up to three hours after
anaphylaxis
 You might be tested for allergies with skin tests or blood tests to help
determine your trigger

Many conditions have signs and symptoms similar to those of anaphylaxis.

Your doctor will want to rule out other conditions.

Treatment

During an anaphylactic attack, you might receive cardiopulmonary

resuscitation (CPR) if you stop breathing or your heart stops beating. You
might also be given medications, including:

 Epinephrine (adrenaline) to reduce your body's allergic response

 Oxygen, to help you breathe
 Intravenous (IV) antihistamines and cortisone to reduce
inflammation of your air passages and improve breathing
 A beta-agonist (such as albuterol) to relieve breathing symptoms

What to do in an emergency

If you're with someone who's having an allergic reaction and shows signs
of shock, act fast. Look for pale, cool and clammy skin; a weak, rapid
pulse; trouble breathing; confusion; and loss of consciousness. Do the
following immediately:
  Call 911 or emergency medical help.
 Use an epinephrine autoinjector, if available, by pressing it into the
person's thigh.
 Make sure the person is lying down and elevate his or her legs.
 Check the person's pulse and breathing and, if necessary, administer
CPR or other first-aid measures.

Using an autoinjector

Many people at risk of anaphylaxis carry an autoinjector. This device is a

combined syringe and concealed needle that injects a single dose of
medication when pressed against the thigh. Always replace epinephrine
before its expiration date, or it might not work properly.

Using an autoinjector immediately can keep anaphylaxis from worsening

and could save your life. Be sure you know how to use the autoinjector.
Also, make sure the people closest to you know how to use it.

Long-term treatment

If insect stings trigger your anaphylactic reaction, a series of allergy shots

(immunotherapy) might reduce your body's allergic response and prevent a
severe reaction in the future.

Unfortunately, in most other cases there's no way to treat the underlying

immune system condition that can lead to anaphylaxis. But you can take
steps to prevent a future attack — and be prepared if one occurs.

 Try to avoid your allergy triggers.

 Carry self-administered epinephrine. During an anaphylactic attack,
you can give yourself the drug using an autoinjector.

Investigate and write all about the Scombroid toxicity, symptoms and
signs, treatment. 

Scombroid poisoning occurs after the ingestion of fresh, canned or smoked

fish with high histamine levels due to improper processing or storage. First
described in conjunction with fish in the suborder Scombroidea (e.g., tuna
and mackerel), it has since been described with other dark-fleshed fish
(e.g., sardines and anchovies). Scombroid poisoning is one of the most
common causes of morbidity associated with fish intake
Symptoms of scombroid poisoning include flushing, rash, urticaria
(generally widespread erythema, usually lacking wheals), palpitations,
headache, dizziness, sweating, and burning of the mouth and throat.
Gastrointestinal symptoms can include abdominal cramps, nausea,
vomiting and diarrhea.

ost instances of scombroid poisoning are self-limited. However, if the

patient has symptoms severe enough to require treatment, rapid-acting
antihistamines (usually H1-receptor antagonists) are commonly used, along
with supportive care tailored to the symptoms. Adrenalin and
corticosteroids are generally not indicated.1,2,5 To prevent further instances
of poisoning, public health authorities should be notified to investigate the
source and remove the implicated product from distribution.

Investigate and write all about the Meningitis ( bacterial and viral ). 

Bacterial Meningitis
Bacterial meningitis is serious. Some people with the infection die and
death can occur in as little as a few hours. However, most people recover
from bacterial meningitis. Those who do recover can have permanent
disabilities, such as brain damage, hearing loss, and learning disabilities.

Causes

Several types of bacteria can cause meningitis. Leading causes in the

United States include

 Streptococcus pneumoniae
 Group B Streptococcus
 Neisseria meningitidis
 Haemophilus influenzae
 Listeria monocytogenes
 Escherichia coli

Mycobacterium tuberculosis, which causes tuberculosis or TB, is a less

common cause of bacterial meningitis (called TB meningitis).

Many of these bacteria can also be associated with another serious illness,
sepsis. Sepsis is the body’s extreme response to infection. It is a life-
threatening medical emergency. Sepsis happens when an infection triggers
a chain reaction throughout your body. Without timely treatment, sepsis
can quickly lead to tissue damage, organ failure, and death.

Some causes of bacterial meningitis are more likely to affect certain age
groups:

 Newborns: Group B Streptococcus, S. pneumoniae, L.

monocytogenes, E. coli
 Babies and young children: S. pneumoniae, N. meningitidis, H.
influenzae, group B Streptococcus, M. tuberculosis
 Teens and young adults: N. meningitidis, S. pneumoniae
 Older adults: S. pneumoniae, N. meningitidis, H. influenzae, group
B Streptococcus, L. monocytogenes

Signs and Symptoms

Meningitis symptoms include sudden onset of

 Fever
 Headache
 Stiff neck

There are often other symptoms, such as

 Nausea
 Vomiting
 Photophobia (eyes being more sensitive to light)
 Altered mental status (confusion)

Newborns and babies may not have, or it may be difficult to notice the
classic symptoms listed above. Instead, babies may

 Be slow or inactive
 Be irritable
 Vomit
 Feed poorly
 Have a bulging fontanelle (the “soft spot” on a baby’s head)
 Have abnormal reflexes

If you think your baby or child has any of these symptoms, call the doctor
right away.
Typically, symptoms of bacterial meningitis develop within 3 to 7 days
after exposure; note, this is not true for TB meningitis, which can develop
much later after exposure to the bacteria.

People with bacterial meningitis can have seizures, go into a coma, and
even die. For this reason, anyone who thinks they may have meningitis
should see a doctor as soon as possible.

Diagnosis

If a doctor suspects meningitis, they will collect samples of blood or

cerebrospinal fluid (fluid near the spinal cord). A laboratory will test the
samples to see what is causing the infection. Knowing the specific cause of
meningitis helps doctors treat it.

Treatment

Doctors treat bacterial meningitis with a number of antibiotics. It is

important to start treatment as soon as possible.

Prevention

Vaccination

Vaccines are the most effective way to protect against certain types of
bacterial meningitis. There are vaccines for 4 types of bacteria that can
cause meningitis:

 Meningococcal vaccines help protect against N. meningitidis

 Pneumococcal vaccines help protect against S. pneumoniae
 Haemophilus influenzae serotype b (Hib) vaccines help protect
against Hib
 Bacille Calmette-Guérin vaccine helps protect against tuberculosis
disease, but is not widely used in the United States

Make sure you and your child are vaccinated on schedule.

Like with any vaccine, these vaccines do not work 100% of the time. The
vaccines also do not protect against infections from all the types (strains) of
each of these bacteria. For these reasons, there is still a chance vaccinated
people can develop bacterial meningitis.
Viral Meningitis

iral meningitis (when meningitis is caused by a virus) is the most common

type of meningitis. Most people get better on their own without treatment.
However, anyone with symptoms of meningitis should see a doctor right
away because any type of meningitis can be serious. Only a doctor can
determine if someone has meningitis, what is causing it, and the best
treatment. Babies younger than 1 month old and people with weakened
immune systems are more likely to have severe illness from viral
meningitis.

Causes

Non-polio enteroviruses are the most common cause of viral meningitis in

the United States.  Only a small number of people infected with
enteroviruses will develop meningitis.

Other viruses that can cause meningitis are

 Mumps virus
 Herpesviruses, including Epstein-Barr virus, herpes simplex viruses,
and varicella-zoster virus (which causes chickenpox and shingles)
 Measles virus
 Influenza virus
 Arboviruses, such as West Nile virus
 Lymphocytic choriomeningitis virus

People at Risk

People of any age can get viral meningitis. However, some people have a
higher risk of getting the disease, including:

 Children younger than 5 years old

 People with weakened immune systems caused by diseases,
medications (such as chemotherapy), and recent organ or bone
marrow transplantations

Babies younger than 1 month old and people with weakened immune
systems are also more likely to have severe illness.

How It Spreads
Close contacts of someone with viral meningitis can become infected with
the virus that made that person sick. However, these close contacts are not
likely to develop meningitis. Only a small number of people who get
infected with the viruses that cause meningitis will develop viral
meningitis.

Viruses that can cause meningitis spread in different ways. Learn more
about how the following viruses spread by visiting CDC’s websites:

 Non-polio enteroviruses
 Mumps virus
 Herpesviruses, including Epstein-Barr virus, herpes simplex viruses,
and varicella-zoster virus
 Measles virus
 Influenza virus
 Arboviruses, like West Nile virus
 Lymphocytic choriomeningitis virus

Symptoms

Common symptoms in babies

 Fever
 Irritability
 Poor eating
 Sleepiness or trouble waking up from sleep
 Lethargy (a lack of energy)

Common symptoms in children and adults

 Fever
 Headache
 Stiff neck
 Photophobia (eyes being more sensitive to light)
 Sleepiness or trouble waking up from sleep
 Nausea
 Irritability
 Vomiting
 Lack of appetite
 Lethargy (a lack of energy)
Most people with mild viral meningitis usually get better on their own
within 7 to 10 days.

Initial symptoms of viral meningitis are similar to those for bacterial

meningitis. However, bacterial meningitis is usually severe and can cause
serious complications, such as brain damage, hearing loss, or learning
disabilities. The pathogens (germs) that cause bacterial meningitis can also
be associated with another serious illness, sepsis. Sepsis is the body’s
extreme response to infection. Without timely treatment, sepsis can quickly
lead to tissue damage, organ failure, and death.

See a doctor right away if you think you or your child might have
meningitis. A doctor can determine if you have the disease, what is causing
it, and the best treatment.

Diagnosis

Doctors diagnose meningitis by ordering specific lab tests on specimens

from a person suspected of having meningitis. If a doctor suspects
meningitis, he or she may collect samples for testing by

 Swabbing your nose or throat

 Obtaining a stool sample
 Taking some blood
 Drawing fluid from around your spinal cord

Treatment

In most cases, there is no specific treatment for viral meningitis. Most

people who get mild viral meningitis usually recover completely in 7 to 10
days without treatment. Antiviral medicine may help people with
meningitis caused by viruses such as herpesvirus and influenza.

Antibiotics do not help viral infections, so they are not useful in the
treatment of viral meningitis. However, antibiotics do fight bacteria, so
they are very important when treating bacterial meningitis.

People who develop severe illness, or are at risk for developing severe
illness, may need care in a hospital.

Prevention

There are no vaccines available in the United States to protect against non-
polio enteroviruses, which are the most common cause of viral meningitis.
The best way to help protect yourself and others from non-polio enterovirus
infections is to

 Wash your hands often with soap and water for at least 20 seconds,
especially after changing diapers or using the toilet
 Avoid close contact, such as touching and shaking hands, with
people who are sick
 Clean and disinfect frequently touched surfaces
 Stay home when you are sick and keep sick children out of school

Vaccines can protect against some diseases, such as measles, mumps,

chickenpox, and influenza, which can lead to viral meningitis. Make sure
you and your child are vaccinated on schedule.

Avoid bites from mosquitoes and other insects that carry diseases that can
infect humans.

Control mice and rats. If you have a rodent in or around your home, follow
appropriate cleaning and control precautions.

Do the exercise from page 21. Complete the questions and give reasons.

1. Is it possible to get anaphylactic shock on first contact with an

allergen? Give reasons.

On first contact with the allergen , there is no allergic reaction but the body
produces antigen specific immunoglobulin E.

2. Would cooking the fish prevent scombroid toxicity? Give reasons.

Scombroid toxicity is caused by eating fish which is not fresh

3. Why are the symptoms of anaphylactic shock and scombroid toxicity

very similar?

because they are produced by food and are very similar conditions

4. From the information you have, which do you think is the mostlikely
diagnosis for Mr. Legrange. Give reasons.

anaphylactic shock, him blood pressure drops suddenly and your airways
narrow, possibly blocking normal breathing.

Write 5 advice you would give to your classmate is about to start work
in the Emergency Department. 
 1. try to rest very well
2. keep up-to-date on the proper treatment to give to the passers-by
3. know how to give first aid
4. to be on time
5. be friendly and efficient

Complete the exercise C on page 27,answer the questions. 

1.According to the article, how many difterent Eypes of bacteria are

responsible for meningitis?

4 types of batteries are responsible

2.0f these bacteria, which do you think are most likely to be

nesponsible for Susan's meningitis?

Haemophilus influenza

3.dentifying the specific bacteria takes at least 24 hours and Susan

needs treatment urgently. Which antibiotics would you give?

Cephalosporins

4 Explain why it is important that steroids are given early in the

treatment of meningitis

It is therefore crucial that the steroids are given before or with the first dose
of antibiotics so that they present in the tissues when the initial
inflammatory burst occurs.