Allergic Reaction Cme SARAH

8/6/2019 Allergic Reaction Cme SARAH

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Presented by: Chris McAllister

Allergic Reaction Allergic Reaction



Allergic Reaction, Definition

An immune system response to acertain substance that the body

mistakenly interprets as harmful.



Allergic Reaction,

Anaphylaxis defined

A sudden, severe allergic reaction

that involves various areas of thebody simultaneously or causes

difficulty breathing and swelling of

the throat and tongue. In extreme

cases, it can cause death. This type

of reaction is sometimes called a

systemic, or general body, reaction

or allergic shock.



Allergic ReactionAllergic reaction is the bodys response (hyper-

response) to antigens outside the body

The bodys allergic response is the ALLERGIC REACTION

ANTIGEN is what the body responds to. i.e., the bee sting. A substancethat is capable of causing the production of an antibody

ANTIBODY, also known as an immunoglobulin, is a large Y-shaped proteinused by the immune system to identify and neutralize foreign objects likebacteria and viruses



Allergic Reaction, Antigen

An ANTIGEN enters the body by:� Injection

� Ingestion

� Inhalation

� Absorption



Allergic Reaction

Antigens may be:

� Drugs

� Foods

� Insect Venoms

� Animal Serum

� Bacteria

� Mold

� Pets

� Incompatible blood types



Allergic Reaction

The ANTIGEN induces ANTIBODY formation when the body deems theantigen as a threat.

The antigen binds with antibody as shown above. This is the less severeallergic reaction, and causes inflammatory response.



Allergic reactions

� Allergic reactions vary in severity from

extremely mild to deadly

� A person may have an allergic reaction at to

anything at any age without history of allergic

reactions in past� People with history of allergic reaction may

have their own Epi pen or medical jewelry



Allergic Reaction

Mild allergic reactions may cause the following:

� Coughing, sneezing, red, watery eyes and nasal congestion� Fever

� Uticaria (hives), or raised swellings on the skin that itch

� Itching (with or without visible changes in skin)

� Joint or muscle aches

� Redness of the skin or a rash

� Swelling of the tongue, eyelids, or face

� Worsening of Asthma or an asthma flare-up, which makes breathing

difficult

�

Anxiousness



Allergic Reaction

Moderate/Severe reactions may

cause more severe cases of mildsymptoms, plus:

� Abdominal distress or cramping

� Chest tightness/ discomfort

�Difficulty swallowing

� Dizziness or light-headedness

� Unconsciousness

� Respiratory distress/arrest

(Type 1 allergic reactions)

� Wheezing/Stridor

� Palpitations

� Swelling of face, mouth, tongue

� Rapid onset severe symptoms

� Weakness

� Nausea, Vomiting, Diarrhea



Allergic ReactionA TYPE 1 ALLERGIC REACTIONS

OCCUR WHEN ANTIBODIESATTACH THEMSELVES TO MAST

CELLS OR BASOPHYLLS.

� Once antibodies attach to MASTCELLS the white blood cells producean antibody specific to that antigen.This is called "sensitization."

�

Now that they are sensitized, thenext time the body comes in contactwith antigen the cells willdegranulate and release mediators,causing a cascade=

SEVERE ALLERGIC REACTION





Allergic reaction

When the mast cell is activated� Histamine is released and heads for specific cell surface histamine

receptors, called H1-receptors; present on most cells in the body. Theiroccupation by histamine results in the symptoms of allergic disease.

� Histamine activates the enzyme phospholipase A, which in turn releasesarachidonic acid--a fatty acid--from the phospholipid membrane of the

mast cell. Leukotrienes are created� In addition to their constricting effect on bronchial muscle, the

leukotrienes also act on blood vessels, causing them to become leaky andresulting in the swelling of the skin. Leukotrienes are powerful chemoattractants, recruiting eosinophils and thus contributing to the ongoingallergic inflammation.



Allergic Reaction

H1 Histamine receptors

cause:� Smooth muscle contraction

� Increased vascular

permiability/vasodialation

� Prostaglandin degranulation

(further dilation and lowers B/P,

Bronchoconstriction)

� Enhanced mucus production

� Pruritis (itching)



Allergic Reaction

H2 receptors cause:

� Increased vascular permeability

� Gastric acid secretion

� Stimulation of suppressor

lymphocytes� Decreased PMN enzyme release

� Increased release of histamine

from Mast cells and Basophylls



Allergic Reaction

And finally H3 receptors cause:

� Inhibition of central and peripheral nervous system neurotransmitter

release

�

Further histamine formation and release



Allergic Reaction

LETS CUT THE MUMBOJUMBOá..

WHAT DOES THIS ALL MEAN FOR THE PATIENT?

WHAT DOES THIS ALL MEAN FOR EMS?

WHAT CAN WE DO FOR OUR PATIENT TOENSURE SURVIVAL?



Allergic Reaction

RAPID INTERPRETATION OF PATIENT SIGNS AND

SYMPTOMS AND KNOWLEDGE OF LOCALCLARK COUNTY PROTOCOLS WILL ENSURE

SURVIVAL OF YOUR PATIENT



Allergic Reaction

UNDERSTANDING WHAT IS HAPPENINGINSIDE YOUR PATIENTS BODY DURINGAN ALLERGIC REACTION WILL HELP YOUTO IDENTIFY THE PROBLEM AND TREAT EFFECTIVELY



Allergic Reaction, THE BREAK DOWN

When an allergen enters the body turns into a mean militarymachine! The body wants:

To STOP the entry process

To DESTROY the enemy

To MINIMIZE exposure/damageTo expedite the REMOVAL of

the attack



STOP ENTRY PROCESSSo why would the body

willingly bronchoconstrictand release chemicals thatcause breathing difficulty?

This is the bodys way of closing itsself off to pathogens it suspectsare out in the environment duringan attack.

Causes respiratory distress, stridor,airway obstruction

NO FURTHER INVASION!!!



DESTROY THE ENEMY!

Antibodies detect and destroy substances that cause disease and sickness. Inallergic reactions, the antibody is called immunoglobulin E, or IgE

Mediators activate more white blood cell defenders.

Activated mast cells and basophils undergo a process called degranulation,during which they release histamine and other inflammatory chemicalmediators (Cytokines, interleukins, leukotreines, and prostaglandins)

THIS IS ALL TO SEEK OUT AND DESTROY THE INTRUDER!



MINIMIZE EXPOSURE TIME

� Vasodialation-Decreased peripheral

resistance. Body does not want to pumpantigen throughout body. Causes peripheral

hypo perfusion, increased HR, hypotension.

� Increased tissue permeability and

leakage from vascular space- Dump

antigen out of circulation. Cause of

hypovolemic shock.

� Increased tissue permiability-

Breakdown of cells to leak out contents. Tissue

edema, uticaria, itching.



REMOVAL OF ATTACK

� Spasms of GI tract- Causes diarrhea, nausea, vomiting and cramping.Flush/ rid body of antigen

� Spasm of Bladder- Causing urinary urgency/incontinence to flushbody

� H

yper production of mucus- Trap and remove antigen





Allergic Reaction� OXYGEN-Oxygen is essential for cell metabolism, and in turn, tissue

oxygenation is essential for all normal physiological functions.

� BENADRYL-H1 receptor antagonist. Blocks the effect of histamine. Benadrylinhibits most responses of smooth muscle to histamine and acts as avasoconstrictor by inhibiting the vasodilator effects of histamine. The antagonismmay also produce anticholinergic effects, antiemetic effects, and significantsedative side-effects.

� ALBUTEROL- Short-acting 2-adrenergic receptor agonist used for the

relief of bronchospasm.

� EPINEPHRINE- Is a hormone and a neurotransmitter. It increases heartrate, constricts blood vessels, dilates air passages and participates in the fight-or-flight response of the sympathetic nervous system.

� NACL- Combats loss of blood pressure and circulation during Anaphylacticshock



Allergic Reaction

MILD ALLERGIC REACTION:

� If patient treated with Benadryl pills at home, notehow many milligrams and time taken.

� Monitor A,B,C·s closely!!! Obtain thorough history of

allergic reactions in the past. IV/02.� If bee sting, remove bee stinger with credit card to

scrape off, try not to break inside patient·s skin.

� May require Benadryl 50 mg. IV/IM and possible

breathing treatment if wheezing present.



Allergic Reaction� MODERATE ALLERGIC REACTION: Monitor A,B,CÙs closely!!!

� High flow 02 (be prepared to control airway)

� IV fluids if hypo perfusion (titrate to 90mm systolic)

� EKG monitor

� Benadryl 50 mg. IM or IV ADULT

� Benadryl 1 mg/kg IV/IM PEDIATRIC

� If Wheezing present, treat with Albuterol until improves



Allergic ReactionSEVERE ALLERGIC REACTION/ANAPHYLAXIS:

ANGIOEDEMA/STRIDOR and/or SHOCK, TREAT SHOCK!

� A·s and B·s- Protect airway as needed, high flow 02, may needBVM. May need to use in-line nebulizer with BVM for Albuterol.

� C·s- 2 Large bore IV·s, treat NACL wide open. Titrate B/P

�

Cardiac monitor, Benadryl, and Albuterol as before� Epinephrine .5 mg 1:1,000 IM every 15 minutes per pt. condition

(max 1.5 mg)

� IF imminent circulatory collapse is likely treat Epinephrine .5 mg1:10,000 IV



Allergic ReactionONE CONSIDERATION AT THE

TRACK IS ACTIVATING THERESPONSE OF A

TRANSPORTING AGENCY.

RESPIRATORY ARREST IS A

PARAMOUNT CONCERN IN

ALLERGIC REACTION!

ACTIVATE TRANSPORTING

AGENCY EARLY.



Allergic Reaction

The hospital has more options to treat the patient with, including steroids,

mast cell stabilizers, compounds thought to impair eosinophil chemotaxis,

Anti-leukotrienes , immunotherapy, etc

Doctors frequently order test that may pinpoint what the patient is allergic to.

Skin tests, lab work, challenge testing, and patch testing are just a few of

the tests performed. Many people may never find what they had the

reaction to, but may be prescribed a life saving Epi-pen in case of another

reaction



Allergic Reaction

Be

Knowledgeable,

be

ready!

Thank you!

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Allergic Reaction Cme SARAH