The immune and lymphatic systems, infection and sepsis
Ian Peate, Helen Dutton in Acute Nursing Care, 2014
This chapter focuses on the immune and lymphatic systems and the nurse's role in the recognition and management of patients who are at risk of acute deterioration due to altered immunity and sepsis. It reviews the important cellular and chemical components that seek and destroy invading micro-organisms in order to protect the body from infection. This coordinated response is the role of the immune and complement systems and in combination with the body's natural defences protects from a multitude of microbes. The chapter further describes the spread of microbes and the role of health care professionals in actively preventing the spread of health care associated infections (HCAIs). The role of the nurse is crucial in recognising the early signs of infection and in the delivery of evidence-based care to those who experience acute deterioration from problems related to immunity and infection. It explores the clinical problems that lead to a medical emergency of anaphylaxis and sepsis.
The Gastrointestinal System
Julian Burton, Sarah Saunders, Stuart Hamilton in Atlas of Adult Autopsy Pathology, 2015
The normal stomach is a highly distensible flask-like organ in the upper abdominal cavity. At autopsy, it is typically opened at the fundus, and this allows the collection of the gastric contents, which should be measured and described. In suspected deaths from anaphylaxis, the stomach contents should be photographed. The stomach can then be opened along the greater curve to permit inspection of the mucosa. Normal gastric mucosa is tan, glistening, and thrown into rugae.
Anaphylactic Shock
Samuel M. Galvagno in Emergency Pathophysiology, 2003
The word anaphylaxis means without protection.1 The current understanding of this disease has revealed that anaphylaxis is an overreaction of the normal immune system as opposed to a delayed or absent response. In the most severe cases, the clinical presentation consists of sudden hypotension with or without bronchospasm or laryngeal obstruction. The differential list is not long and the pharmacologic treatment is straightforward. Patients with anaphylaxis can be assessed and promptly treated before ED arrival. Indeed, the successful recognition and management of anaphylaxis can be extremely rewarding for both patient and provider; in many cases the patient’s response to therapy can be quite dramatic.
Emergency anaphylaxis protocols: A cross-sectional analysis of general practice surgeries and pharmacies in both the urban and rural setting in Ireland
Published in European Journal of General Practice, 2018
Hannah O’Brien, David Mc Conaghy, Declan Brennan, Sarah Meaney
Background: The incidence of anaphylaxis appears to be increasing worldwide with cases in the community outnumbering those in the hospital setting. General practice (GP) surgeries and pharmacies, based in the community, are often the first point of contact for many patients suffering from anaphylaxis. Objectives: To determine if studied GP surgeries and pharmacies have an anaphylaxis protocol on site and have access to an anaphylaxis kit; to explore GP’s and pharmacists’ personal experiences with management of anaphylaxis. Methods: A cross-sectional, questionnaire-based study was performed examining anaphylaxis protocols in a sample of general practices and pharmacies from some counties in Ireland. This consisted of a sample from rural and urban settings. The study commenced in October 2014. Results: Nineteen of 24 GPs (79%) and 9 (29%) pharmacies had an anaphylaxis protocol (P < 0.001). Twenty-four (100%) GP practices and 12 pharmacies (39%) surveyed had an anaphylaxis kit on site. Twelve GPs (50%) had treated a patient with anaphylaxis in the surgery while 8 (33%) had treated a patient in the community. One pharmacist (3%) had witnessed anaphylaxis in practice. Two pharmacies and one GP had been contacted by local businesses to alert them to a case of anaphylaxis. Conclusion: In contrast to national and international guidelines only 79% of GPs and 29% of pharmacies in this study from Ireland had an anaphylaxis protocol onsite.
Risk factors and treatment of refractory anaphylaxis - a review of case reports
Published in Expert Review of Clinical Immunology, 2018
Wojciech Francuzik, Sabine Dölle, Margitta Worm
ABSTRACT Introduction: Patients experiencing anaphylaxis who do not recover after treatment with intramuscular adrenaline are regarded as suffering from refractory anaphylaxis. The incidence of refractory anaphylaxis is estimated to range between 3–5% of anaphylaxis cases. The risk factors for refractory anaphylaxis are unknown. Areas covered: In the present analysis, we aimed to evaluate the management and risk factors of refractory anaphylaxis to highlight possible clinical implications for updating current management algorithms. Expert commentary: According to international guidelines, adrenaline given through the intramuscular (i.m.) route is a rapid and safe treatment but may be insufficient. Therefore, defined standardized treatment protocols for such cases of refractory anaphylaxis are needed to optimize the treatment. Point-of-care diagnostics may enable doctors to identify patients experiencing severe, refractory anaphylaxis early in order to initiate intensified critical care treatment.
Optimal Treatment of Anaphylaxis: Antihistamines Versus Epinephrine
Published in Postgraduate Medicine, 2014
Anaphylaxis is a rapid, systemic, often unanticipated, and potentially life-threatening immune reaction occurring after exposure to certain foreign substances. The main immunologic triggers include food, insect venom, and medications. Multiple immunologic pathways underlie anaphylaxis, but most involve immune activation and release of immunomodulators. Anaphylaxis can be difficult to recognize clinically, making differential diagnosis key. The incidence of anaphylaxis has at least doubled during the past few decades, and in the United States alone, an estimated 1500 fatalities are attributed to anaphylaxis annually. The increasing incidence and potentially life-threatening nature of anaphylaxis coupled with diagnostic challenges make appropriate and timely treatment critical. Epinephrine is universally recommended as the first-line therapy for anaphylaxis, and early treatment is critical to prevent a potentially fatal outcome. Despite the evidence and guideline recommendations supporting its use for anaphylaxis, epinephrine remains underused. Data indicate that antihistamines are more commonly used to treat patients with anaphylaxis. Although histamine is involved in anaphylaxis, treatment with antihistamines does not relieve or prevent all of the pathophysiological symptoms of anaphylaxis, including the more serious complications such as airway obstruction, hypotension, and shock. Additionally, antihistamines do not act as rapidly as epinephrine; maximal plasma concentrations are reached between 1 and 3 hours for antihistamines compared with < 10 minutes for intramuscular epinephrine injection. This demonstrates the need for improved approaches to educate physicians and patients regarding the appropriate treatment of anaphylaxis.
Related Knowledge Centers
- Allergy
- Respiratory System
- Epinephrine
- Immune System
- Pathophysiology
- Hypotension
- White Blood Cell