Transcript File - Huff Hills Ski Patrol

Chapter 14
Allergies and
Anaphylaxis
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
14.1 Define the following terms:
◦
◦
◦
◦
◦
allergy
allergic reaction
anaphylaxis
antigen
hypersensitivity
14.2 List four routes by which an antigen may
enter the body.
14.3 List four potential allergy sources.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Objectives
14.4 List the signs and symptoms of an
anaphylactic reaction.
14.5 Describe and demonstrate the steps for
properly using portable epinephrine
auto-injectors.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Topics
 Anatomy
and Physiology
 Common Causes of Allergies and
Anaphylaxis
 Assessment
 Management
 Chapter Summary
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Presentation
A hiker complains of shortness of breath and that her
tongue feels “fat” after photographing some wild
flowers 15 minutes ago.
She denies any medical problems but states, “I am
deathly allergic to bees!”
Although she does not believe she was stung, you
notice a few honeybees buzzing around a stump a
few feet away.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
 Immune
system: Protects the body
from foreign substances, or antigens,
by developing antibodies.
 Primary components: Mast cells,
white blood cells, hormones, bone
marrow, thymus, and spleen.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Anatomy and Physiology
 Antibody-antigen
reaction: Mast cells
attack the offending antigen, which
causes a reaction that destroys it
without harming normal cells.
 Allergic reaction: An acquired,
abnormal over-reaction by the
immune system to an otherwise
harmless substance that results in a
hypersensitivity.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Common Causes
of Allergies and Anaphylaxis
 Foods
, especially peanuts and
shellfish
 Environmental irritants
 Pollen
 Molds
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Common Causes
of Allergies and Anaphylaxis
 Animal
dander
 Medications
 Chemicals
 Other such as blood transfusion
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Common Causes
of Allergies and Anaphylaxis
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Mild Allergic Reaction
 Typically
results in local dermatologic
changes, especially on the face
and/or neck. Nasal mucosa and/or
congestion are also common.
 Symptoms may take minutes, hours,
or even days to develop.
 Effects usually disappear over time or
with treatment.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Mild Allergic Reaction
BRADY
Signs and Symptoms
 Itching (pruritis)
 Flushed skin
 Rash or hives (urticaria)
 Watery, reddened eyes
 Nasal congestion
 Increased heart rate
 Tingling in/around mouth
 Fatigue
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Moderate Allergic Reaction
 Effects
include those in a mild
reaction, but more pronounced.
 The respiratory and gastrointestinal
system are usually involved.
 Symptoms may take minutes, hours,
or even days to develop.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Moderate Allergic Reaction
 Effects
might disappear over time, or
increase in severity, depending on
individual chemistry and response.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Moderate Allergic Reaction
Signs and Symptoms
 Anxiety and confusion
 Tightness in the throat
 Difficulty swallowing and/or breathing
 Wheezing
 Rash, hives, swelling in face, neck,
chest, arms
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Moderate Allergic Reaction
Signs and Symptoms
 Persistent itching
 Angioedema
 Abdominal pain or cramping
 Nausea and/or vomiting
 Elevated vital signs
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Moderate Allergic Reaction
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Severe Allergic Reaction
 Causes
a massive inflammatory
response in the respiratory,
integumentary, circulatory, and
gastrointestinal systems due to
massive histamine release.
 Effects are almost immediate- within
seconds or minutes.
 If not treated quickly, it can lead to continued
anaphylactic shock and/or death.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Severe Allergic Reaction
Signs and Symptoms
 Severe anxiety, impending doom
 Decreased level of responsiveness
 Severe respiratory distress;
 Severe angioedema, hives
 Abnormal lung sounds
 Inability to swallow
BRADY
continued
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Severe Allergic Reaction
Signs and Symptoms
 Tachycardia, weak peripheral pulses
 Hypotension, pallor, cyanosis
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Preventing Allergic Reaction
 Triple
A Approach:
◦ Awareness – of one’s allergies and the
triggers
◦ Avoidance – of contact with known
allergens
◦ Action – know what to do if an allergic
reaction occurs (emergency and selfcare)
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Update
She looks pale and appears to be in mild respiratory
distress. Once you determine that the ABCDs are
intact, you notify dispatch to send additional
personnel with oxygen and an airway kit. You also
request that an ALS provider respond. Respirations
are 38 per minute and labored. The patient’s face
appears swollen.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Assessment
Moving patient may be necessary before
assessment.
 Severity of allergic reaction determines
timing, esp. if anaphylaxis is present.
 Observe closely skin, face, neck, and
eyes for rash, swelling, breathing.
 Extend questioning during known
allergies part of SAMPLE (EpiPen)

BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
 Initial
management is similar- ABCDs.
 Try to identify the allergen.
 Remove the patient from the allergen
if possible.
 Monitor and check vitals frequently.
 If signs of anaphylaxis appear, treat
ABCDs and seek transport and ALS.
 Insect bite? Remove stinger if
possible.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Management
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Epinephrine
 Drug
of choice for managing severe
allergic reaction.
 Promotes bronchodilation and
vasoconstriction to relieve dyspnea
and hypotension.
 Comes pre-packed in adult and
pediatric doses (“EpiPen”).
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Epinephrine
 Those
with severe allergies will often
have an EpiPen with them.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Epinephrine
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Epinephrine
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Case Disposition
Other OEC Techs soon arrive with oxygen and a
wheeled litter basket. You place the patient on a
nonre-breather mask at 15 LPM. You locate her
EpiPen™ and assist her in administering the
medication in the lateral side of her thigh. Within a
few minutes, she is breathing more easily, and her
facial swelling begins to diminish.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
 An
allergy is the body’s overreaction
to a foreign substance.
 Allergies are caused by antigens
called allergens.
 Many people do not know they have
an allergy until they suffer
 an allergic reaction.
continued
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
 Tongue
swelling is an ominous sign of
an allergic reaction.
 Anaphylaxis can be fatal unless
rapidly treated.
 Peanuts are the number one food
allergy in the world.
 Allergic reactions may be prevented
using the Triple A approach.
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ
Chapter Summary
 Triple
A Approach:
◦ Awareness – of one’s allergies and the
triggers
◦ Avoidance – of contact with known
allergens
◦ Action – know what to do if an allergic
reaction occurs (emergency and selfcare)
BRADY
National Ski Patrol, Outdoor Emergency Care, 5th Ed.
©2012 by Pearson Education, Inc., Upper Saddle River, NJ