Miscellaneous Important Question and Answers

Miscellaneous

Question. Write short note on anaphylactic shock.
Or
Write notes on anaphylaxis.
Or
Discuss anaphylaxis and its management in detail

Answer. Anaphylaxis is an acute and dramatic life­threatening immunological reaction to a drug or other stimulus.

Etiology

• Antibiotics: Penicillin and streptomycin.
• Radio contrast media
• Anesthetic agent, i.e. lignocaine
• Blood and blood products including sera.
• Hormones: Insulin and growth hormone.
• Venoms: Bees, spiders and wasps
• Others: NSAIDs, narcotic agents, heparin and thrombolytic agents.

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Clinical Features

• Onset may be instantaneous or within a few minutes after the IV injection and 30 minutes after exposure.
• Cardiovascular: Tachycardia, arrhythmia, hypotension and circulatory collapse.
• Respiratory: Laryngeal obstruction, angiedema,bronchospasm or pulmonary edema may occur singly or in combination.
• Nervous: Syncope and seizures.
• GIT: Diaphoresis, abdominal pain and diarrhea may occur.
• Skin: Wheel and erythematous lesions are seen which are circumscribed, round, discrete, erythematous areas with irregular borders and blanched centres.
• Lesions are very pruritic.
• If not treated death may occur.

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Management

Important Questions and Answers for Exams

• Airways: Endotracheal intubation or perform tracheostomy,if intubation is not possible.
• Oxygen is given in high concentration.
• Injection adrenaline 0.5 to 1 mL of 1:1000 solution IM
• Fluids: 0.5 or 1 liter of flid restores blood pressure but 6-9 liters is required for adequate restoration of blood volume.
• Hydrocortisone 300 mg IV.
• Aminophylline 250 mg IV in 20 mL dextrose to revert bronchospasm.
• Diphenhydramine 50 mg IV slowly.
• Dopamine, if hypotension persists.
• IV atropine and glucagon.
• Ventilatory support is necessary, if patient is critical.