Learning Objectives. Introduction. Allergic Reactions 9/18/2012. Allergies - common problem. Antibody-antigen reaction gone haywire

Transcription

1 Chapter 14 Allergies Learning Objectives Describe mechanisms of allergic response, implication for airway management Recognize patient experiencing allergic reaction Describe emergency medical care of patient with allergic reaction State generic, trade names, medication forms, dose, administration, action, & contraindications to epinephrine autoinjector 2 Learning Objectives Explain rationale for administering epinephrine with autoinjector Evaluate need for medical direction of emergency medical care of patient with allergic reaction Differentiate between general category of patients having allergic reaction, requiring immediate medical care, immediate use of epinephrine autoinjector 3 1

2 Learning Objectives Establish relationship between patient with allergic reaction, airway management 4 Introduction Allergies - common problem Signs/symptoms range from simple nasal congestion to anaphylaxis Anaphylaxis life-threatening condition that can result in death within minutes Allergy and anaphylaxis caused by antibodyantigen reaction Release of substances that can cause leakage of fluid in tissues, swelling, and other responses by body systems 5 Allergic Reactions Antibody-antigen reaction gone haywire Effects detrimental rather than protective Histamine release Blood vessels dilate Capillaries leak Lung tissue constricts Allergies localized or systemic 6 2

3 Allergic Reactions Effects Anaphylaxis Involves multiple body systems Leads to shock Tissue swelling Bronchiole constriction Airway obstruction Reaction onset extremely rapid; death in minutes Needs immediate treatment Maintain open airway Stabilize cardiovascular system 7 Allergic Reactions Effects Management of anaphylaxis Quickly recognize signs/symptoms Establish patient airway ensure adequate ventilation Assist previously diagnosed patients who carry an epinephrine autoinjector pen 8 Allergic Reactions Anaphylaxis cause agents Drugs Penicillin Cephalosporins Tetracycline Nitrofurantoin Dyes used for radiographic contrast studies Antiinflammatories 9 3

4 Allergic Reactions Anaphylaxis cause agents Foods Insect bites/stings Latex 10 Allergic Reactions Anaphylactic reactions Constriction of bronchial smooth muscle in airway Increased permeability of capillaries Dilation of arterial vessels Dilation of venous system Increased mucous secretions in respiratory tree & GI tract Severe reaction Shock 11 Scene size-up & initial (primary) assessment BSI precautions Scene safety ABCs 12 4

5 Focused (secondary) assessment Focused history Hypersensitivity history Connect onset of symptoms with recent history/significant exposure Some anaphylactic symptoms occur immediately after antigen contact 13 Focused (secondary) assessment Physical examination Skin & general signs Feeling of warmth precedes reaction Tingling of face/extremities/upper chest Itching/generalized skin flushing Urticaria (hives) Angioedema Nasal congestion/sneezing/itching around eyes Headache Abdominal pain Sense of impending doom

6 16 Focused (secondary) assessment Physical exam Respiratory signs Narrowed airway Cyanosis Accessory muscle use Suprasternal/intercostal retractions Wheezing/noisy breathing Breath sounds absent/diminished Complete airway obstruction/respiratory failure 17 Focused (secondary) assessment Physical exam Cardiovascular signs Leakage of fluid through capillaries Increased blood flow to skin Fluid loss Increased HR/RR Pale/sweaty skin Lower BP/ lower brain perfusion 18 6

7 Management Anaphylactic reaction requires immediate administration of epinephrine Blocks effects caused by antigen-antibody reaction Primary goals Airway management Ventilation Oxygenation Support of circulation Administration of epinephrine Rapid transport 19 Management Lifesaving medications Epinephrine Anaphylactic kit, patient should self-administer ASAP 20 Management Lifesaving medications Epinephrine Rapid onset of action Clinical effect peaks 15 to 20 min after injection Initial improvement, then condition deteriorates May benefit from second injection Consult medical direction Prescribed autoinjector comes as double kit 21 7

8 Skill 14-1: Administering Epinephrine with an Autoinjector Obtain order from medical direction Obtain patient s prescribed autoinjector Check validity of autoinjector 22 Skill 14-1: Administering Epinephrine with an Autoinjector Remove safety cap from autoinjector 23 Skill 14-1: Administering Epinephrine with an Autoinjector Place autoinjector tip against anterior lateral portion of thigh between waist/knee 24 8

9 Skill 14-1: Administering Epinephrine with an Autoinjector Push injector firmly against thigh until activates Hold in place until medication injected Dispose in sharps container Record activity and time 25 Management Respiratory support Complete airway obstruction Rapid transport to ALS essential Intubation/surgical airway to establish patent airway PPV with high-concentration supplemental O 2 during transport 26 Management Respiratory support Respiratory distress/failure High-concentration supplemental O 2 via nonrebreather mask Hypoventilating Give assisted ventilation with 100% O 2 Coordinate rescue breaths with attempt to inspire 27 9

10 Management Cardiovascular support Exhibiting signs of shock Place in supine position Prevent loss of body heat Record vital signs every 5 min Nothing by mouth Rapid transport Consider ALS intercept 28 Allergies/anaphylaxis - Summary Antibody-antigen reaction results in release of substances that affect skin, respiratory, circulatory, GI systems Anaphylaxis, antibody-antigen reaction gone haywire, in which effects are detrimental rather than protective Anaphylaxis often caused by drugs (e.g., antibiotics), foods (e.g., nuts, shellfish, eggs, chocolate, cottonseed oil, grains, beans), insect bites (e.g., bees, yellow jackets, wasps) 29 Summary General signs, symptoms of anaphylaxis include: Tingling of face/extremities/upper chest Itching Generalized flushing of skin Urticaria/hives Angioedema Nasal congestion/sneezing/itching around eyes Headache Abdominal pain Sense of impending doom 30 10

11 Summary Cardiovascular signs of anaphylaxis include: Early signs Flushed skin Higher HR Late signs Pale, cool, clammy skin Lower BP AMS 31 Summary Respiratory signs of anaphylaxis include: Dyspnea Tightness of throat/hoarseness/stridor Cyanosis Use of accessory muscles of breathing/ retractions Wheezing/noisy breathing Signs of complete airway obstruction (inability to speak/cough) Respiratory failure/arrest 32 Summary EMT may assist in administration of epinephrine prescribed by patient s physician with autoinjector; may carry epinephrine on ambulance to treat patients who may not have their medication with them/having first episode of anaphylaxis Epinephrine administered at dose of 0.3 mg to adults, 0.15 mg to children intramuscularly with autoinjector 33 11

12 Summary Rapidly transport patients with anaphylaxis who develop complete airway obstruction to ALS; capabilities/surgical airway (e.g., cricothyroidotomy, tracheostomy) may be needed to restore adequate ventilation 34 Questions? 35 12