Term
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Definition
10 per 100,000
1 in 170 school children |
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Term
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Definition
| severe immediate hypersenstivity reaction affecting multiple organs |
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Term
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Definition
foods - peanuts,seafood,
venoms - bees
medications - penicillin etc
idiopathic |
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Term
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Definition
type I immediate hypersensitivity
1. IgE cross linking of pre-sensitised mast cells
2. degranulation - histamine, serotonin,
and synthesis - prostaglandins and leukotrienes
immediate phase - vasodilation, increased vascular permiability and broncho constriction
3. late phase responce - chemokines released attract secondary inflamatory cells namely eosinophils
continued inflammation and tissue damage |
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Term
| clinical features of anaphylaxis |
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Definition
skin - erythema and angioedema
respiratory - wheeze and stridor
CVS - tachycardia (initially), dizziness, confusion, and collapse
Abdominal - nausea, vomiting, pelvic pain |
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Term
| management of anaphylaxis |
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Definition
* place in supine position, legs raised
* Airway - support, intubate if necessary, oxygen
* breathing- listen for obstruction sounds, auscultation of the chest
* circulation - IV fluids, management of shock
* I.M adrenaline 0.01mg/kg upto 0.5mg
* nebulised adrenaline or bronchodilators for bronchospasm |
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Term
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Definition
Investigations - RAST testing, skin prick testing
Avoidance of allergens and medicines that may complicate management (betablockers)
written anaphylaxis plan
medic alert bracelets
Epipen traing |
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Term
| phathopysiology of unconsiousness |
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Definition
| trauma, lack of oxygen or glucose to both hemispheres or the reticular activing system |
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Term
| causes of unconsciousness |
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Definition
episodic - seizure, syncope, arrythmias, vertebrobasilar insufficiency, hyperventilation,
non episodic - CO2 narcosis, Overdose, Metabolic (DM,ARF, Hepatic failure, adrenal)
Apoplexy - infarctions, haemorrhage, injury, infections |
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Term
| emergancy treatment of unconsciousness |
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Definition
Airway - clearing, head tilt, intubation, oxygen administration
breathing - bag mask ventilation, listen to breath sounds, inspect chest wall movements, auscultate breath sounds
Circulation - BP and pulse, cardiac arrest, haemorrhage, shock, venous access and resusitation
Neuro - brief neuroexam (GCS, pupil reactivity
D - disability , fractures etc
history - AMPLE
Secondary survey |
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Term
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Definition
| food allergy, atopic dermatitis, asthma, allergic rhinitis |
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Term
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Definition
| genetic predisposition to type I immune reactions |
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Term
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Definition
20% of children
50% positive family history |
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Term
| triggers of atopic eczema |
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Definition
foods - eggs, milk, soy, potatoe, wheat
Dust mites
animal danders
pollen
irritatants - soaps, perfumes, sand, wool |
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Term
| management of topic eczema |
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Definition
explain chronic nature of disease
allergen avoidance
avoidance of irritants
good moisture program
antihistamines for itch
corticosteroids for flare upts |
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Term
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Definition
| milk, eggs, peanut, soy, wheat ,nuts, fish , and shell fish |
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Term
| spectrum of food allergies |
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Definition
type I. fast onset, small, volume, immediate hypersensitive, urticaria erythema, angiodemia and vomiting
type II - mixed reaction within 24 hrs, moderate food amounts, GIT effects diarrhoea, colitis, obstructon, IgE and non IgE reactions
Type III - prolonged onset, large volumes, diarrhoea, atopic dermatitis, failure to thrive, relfux and colic, T-cell mediated responce |
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Term
| diagnosis of food allergy |
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Definition
History - timing, previous reactions, types of reactions, Atopic reactions, family history
Investigations - skin prick testing, RAST testing, Total IgE
Confirm - elimination diets, food diaries, oral chalange |
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Term
| symptoms of allergic rhinitis |
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Definition
| sneezing, running, itchy mouth, watery eyes, mouth breathing, sleep diturbancers |
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Term
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Definition
| preformed mediators - vasoactive amines (histamine, adenosine, serontonin) cause bronchoconstriction, vasodilation and increased tissue permiablility. Chemoattractants - chemokine. Enzymes - proteasee. Proteoglycans. sythesised mediatiors - leukotrienes, prostaglandins, platelet activation factor, cytokines (TNF, IL, GM |
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Term
| type II hypersensitivity reaction |
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Definition
| IgG antibody dependant reactions - binding to self or foreign antigens. effectors 1. cell destruction via compliment and cell mediated mechanism. 2 Antibody altering cell signalling (graves disease) |
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Term
| type III hypersensitivity |
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Definition
| Immune complex disease. Normally cleared via blood vessels and splenic removal. excess production causes deposition in blood vessels and tissues eg vasculitis, pneumonitis, arthus reaction, serum sickness |
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Term
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Definition
| delayed hypersensitivity - TH1 and CD8 cells mediated rections. initial contact sensitises the langerhans cells and present to TH2 cells. recontact causes recruitment of macrophages and other inflammatory cells |
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Term
| Pharmacology and pharmacokinetics of adrenaline |
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Definition
pharmacology - acts at alpha and beta adrenoreceptors causing various effects depending of sight .
Pharmacokinetics. Absorption - rapid post IM, not orally available, Distrubion - rapid. metabolism - short half life,inactivated by MAO, COMT and NAD uptake |
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Term
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Definition
| syndrome of inadequate tissue perfusion. presenting as hypotension, tachycardia, oliguria, and altered mental status |
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Term
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Definition
| Hypovolaemic - decreased intravascular volume. Cardiogenic - pump failure (MI, CHF). Distributive - anaphylaxis, sepsis, SIRS, neurogenic. Obstuctive - massive PE, cardiac tamponade, tension pneumothorax |
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Term
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Definition
| pump problems, rate and rhythm problems, obstructions, volume problems, vasodilation |
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Term
| Signs and symptoms of shock |
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Definition
| hypotension, postural hypotension - drop of 15/10 on standing, cold peripheries, weak thready pulse, splanchnic vasoconstriction - oliguria, bowel ischemia, hepatic dysfunction. altered mental state. Hypovolaemic - low JVP, narrow pulse pressure. Cardiogenic - high JVP, loud P2, pulmonary oedema. Obstructive - raised CVP, distended neck veins. Distributive - hyperdynamic heart sound, warm extremities, wide pulse pressure. Neurogenic - no compensatory tachycardia |
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Term
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Definition
1. non-progressive. reflex compensatory mechanisms activated and perfusion of organs is maintaine. blood pressure normal, tachycardia, vasoconstriction, and oliguria
2. progressive - compensatory mechanisms are unable to maintain tissue perfusion. worsening of circulatory dysfunction, metabolic acidosis. tissue hypoxia leads to damage and posititive feed back loops worsening tissue damage. organ failure, confusion, and reduced urinary output
3. irreversable - wide spread tissue injury not sustainable with life even if CVS is stablised. worsening of myocardial dysfunction, ischaemic bowel, renal shut down, coma and death |
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Term
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Definition
Airway breathing and circulation
fluid resusitation, blood, colloids
vasopressors, inotopic agents |
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Term
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Definition
| systemic inflammatory responce to a variety of clinical insults. requires two or more of Temp >38 or <39. HR >90, Resp rate >20 or paCO2 <32, WBC <12000 ro <4000 |
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Term
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Definition
| SIRS plus signs of infection. severe - evidence of organ dysfunction in more than one system (lactic acidosis, confusion, oliguria). Septic shock - shock despite fluid resusitaion |
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Term
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Definition
| 3 triggers - classical, alternitive, mannin-leptin binding pathway. central MOA cleavage of C3. 3 effectors - inflammation (C3a, C5a), obsonisation (C3b), and MAC attack (C5b-C9) |
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Term
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Definition
| LPS - O antigen confirs bacterial resitance to serum. Lipid A endotoxin released on cell lysis, binds to LBP and presented to macrophage (CD14) and activates TLR4 -> release of cytokins activation coagulation and complement cascades. triggers blood clotting, inflammation, opsonisation and MAC attack. small amounts is beneficial, large amount lead to shock and DIC |
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Term
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Definition
| shock, renal, liver, bowel, respiratior, heart failure |
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Term
| MOA of SIRs Gram +ve sepsis |
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Definition
| virulence factions - lipotechoic acids and peptidoglycan. bind to macrophage Cd14 and activate TLR3 ->cytokine release activation clotting and complement cascades. |
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Term
| clinical approach to syncope |
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Definition
History- circumstances prior, prodromal symptoms, speed of onset, witnesses?, recovery, previous episodes, family history, drug history.
Examination - postural hypotension, cardiac murmur, abdominal mass, focal neurological defecits. investigations - blood sugar, ECG, more as guided by above |
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Term
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Definition
| 1. Cardiac - arythmia, Ischemia, obstuctive. 2. peripheral vascular - vasovagal, orthostatic,carotid sinus hypersenitivity 3. Cerebrovascular - SAH, TIA, subclavian steal |
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Term
| differential diagnosis of syncope |
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Definition
| Hypoglycaemia, seizure, hyperventilation, alcohol intoxication, no impairment in consciousness (fall, cataplexy, drop attack, psychogenic) |
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