Medical Emergency:

Anaphylaxis

Carmen Briones,
Shinas Jiffry,
Munesh Karla,
Susan Yeh

June 8th, 2009

Medical Emergencies : Anaphylaxis

 Anaphylaxis
Anaphylaxis is a life-threatening allergic reaction.
Immediate medical intervention is necessary as the
person may suffer from anaphylactic shock involving a
drop in blood pressure, loss of consciousness and death.

Medical Emergencies : Anaphylaxis

What are the common causes of anaphylaxis?

Common causes of anaphylaxis include:

• Food
• Medication
• Insect stings
• Exercise
• Latex

Medical Emergencies : Anaphylaxis

 Food Allergy:

Most common food allergy are nuts, seeds, fish and

crustaceans in adults; cows milk, soy, egg, nuts, and
wheat in young children

Medical Emergencies : Anaphylaxis

Medication (drug allergy): Particularly
painkillers, antibiotics and
local anesthetic

Medical Emergencies : Anaphylaxis

 Itchy hives, which may
blend together to form
larger areas of skin
swelling

Insect Sting (venom allergy)

such as bee, wasp,
"jumper ants".

Medical Emergencies : Anaphylaxis

 Shock

Latex
Allergy

Medical Emergencies : Anaphylaxis

 Symptoms of anaphylactic shock can be
characterized by:

Rapid pulse, sweating, dizziness, fainting,

unconsciousness

Medical Emergencies : Anaphylaxis

Wheezing, chest tightness, difficulty breathing,
coughing

Medical Emergencies : Anaphylaxis

Paleness, bluish or green
skin color

Throat swelling, feeling

of tightness, lump in
the throat,
hoarseness or air
flow obstruction.

Medical Emergencies : Anaphylaxis

Nausea, vomiting, abdominal cramps, diarrhea

Medical Emergencies : Anaphylaxis

Swelling of the lips, tongue or eyes

Medical Emergencies : Anaphylaxis

Cardiac arrest (no effective heartbeat)

Medical Emergencies : Anaphylaxis

 Local Anesthetic
• Allergic reaction to local anesthetic is extremely rare, the allergic
potential would depend on its chemical agent or properties. These
agents are :-

- metabolizes in plasma - metabolizes in liver

- excreations : kidneys - excreations : kidneys
- procaine - lidocaine
- propoxycaine - mepivacaine
- tetracaine - prilocaine
- bupivacaine

» Medical Emergencies : Anaphylaxis

 Factors that influence toxicity include
the following:-
• Drug
• Concentration
• Route of administration
• Rate of injection
• Vascularity
• Patients weight
• Rate of metabolism and excretion
• Chk out slide # 11,12 of PP
Medical Emergencies : Anaphylaxis
• Epinephrine is a vasoconstrictor used to prolong duration of action
• Antioxident : sodium - metabisulfite or bisulfite, is used to retard
oxidation of epinephrine , which could trigger hypersensitivity
reaction like acute asthmatic attack

• WATCH FOR SYMPTOMS OF WHEEZZING OR CHEST TIGHTNESS

• Patients with uncontrolled high BP, hyperthyroidism, angina pictoris,

cardiac arrhythmias, myocardial infraction or
cardiovascular accident in the past 6 months should make the
appointment after the medical condition is
under control.
• All patient that use anesthetic containing
epinephrine should be monitored.
Medical Emergencies : Anaphylaxis
 Anaphylaxis Complications

Shock - Cardiac arrest (no effective heartbeat)

Respiratory arrest (absence of breathing) , airway

Medical Emergencies : Anaphylaxis

Who is at risk for having an anaphylactic reaction?

Previous history of anaphylactic reactions .

• An individual with a personal or family history of allergic
conditions i.e. asthma, eczema, hay-fever, ester, amide or
sulfite.
• Teenagers with these allergies are at a higher risk, since they
eat out more often and tend to forget to carry their
medication with them or may ignore or may not recognize the
symptoms.
• http://members.tripod.com/~PorphBook/40.html
• http://www.novacaine.info/
• http://www.doctorspiller.com/local_anesthetics.htm
Medical Emergencies : Anaphylaxis
 How to identify the cause?

• Ask a series of questions that may help to narrow down the list of causes
i.e. foods or medicines consumed that day, or exposure to stinging
insects.
• A history of everything eaten or drunk in the previous 12 hours is of
utmost importance. Anaphylaxis usually occurs within minutes of a sting,
within hours of a food allergen or drug.

The 3 R’s for managing anaphylaxis:

1. Recognize symptoms
2. React quickly
3. Review what happened and be sure to prevent it from reoccurring.

Medical Emergencies : Anaphylaxis

 Anaphylaxis Emergency and Treatment

1. Assessment of the ABC's.

2. CPR should be initiated especially if the patient is unconcious.
3. Patient who carry Epi-Pen should be assisted if necessary.
4. Paramedics or physicians may include placing a tube through
the nose or mouth into the airway (endotracheal intubation)
or emergency surgery to place a tube directly into the trachea
(tracheostomy or cricothyrotomy).
5. Epinephrine by injection should be given without delay.
6. Treatment for shock includes intravenous fluids and
medications that support the actions of the heart and
circulatory system.
7. Antihistamines and corticosteroids, may be given to further
reduce symptoms (after lifesaving measures and epinephrine
are administered).

Medical Emergencies : Anaphylaxis

 Conclusion
Anaphylaxis may be mild to severe and can be fatal.
Prevention is the best method for avoiding anaphylactic
reactions. Always carry an epinephrine auto-injector and an
antihistamine and have a written emergency plan from your
physician. If you have food allergies, learn how to read labels
for the offending foods, carry safe snacks with you, and when
in doubt, don’t consume a food if you don’t know how it was
prepared.

Medical Emergencies : Anaphylaxis

 References:
• U.S. National Library of Medicine, 8600 Rockville Pike, Bethesda, MD 20894
National Institutes of Health | Department of Health & Human Services
• © 2006-2007 pharmacy-and-drugs.com. All rights reserved.
• AllRefer.com
• A.D.A.M., Inc. (www.urac.org). independent audit. A.D.A.M. is among the first to
achieve this important distinction for online health information and services. Learn
more about A.D.A.M.'s editorial reviewers. A.D.A.M. is also a founding member of
Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the
Net Foundation (www.hon.ch).
• Haveles, Elena B. “Applied Pharmacology for the dental Hygienist”, 5 th edition,
copyright 2007 by Mosby Elesevier Inc.
• www.foodallergy.org/anaphylaxis/index.html
• www.latimes.com/extras/cedars-sinai/november_04/story06.html
• http://www.allergyfreepassport.com/pdf/anaphylaxis_adult_and_kids3.pdf
• PP notes Mr. Amin

Medical Emergencies : Anaphylaxis