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21 Cards in this Set

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What are the origins of latex?
Produced from the rubber tree- lactiferous cell- hevea basilienis
Describe the prevalence of latex allergy
5-17% health care providers
18-73% children with myelodysplasia or congenital urologic anomalies
Describe Type IV reaction
Delayed, immune mediated contact dermatitis- t cells does not involve antibodies or complement
Describe Type I reaction
IgE mediated reactions First exposure sensitizes- b lymphocytes make antibodies. Then second exposure IgE
What does H1 receptor activation do?
Increased capillary permeability, constricts airway and vascular smooth muscle
What is released in Type I reaction?
Mast and basophils degranulate- histamine- prostaglandins, leukotrienes, cytokines, platelet activating factor and eosinophilic chemotactic factor
What does H2 receptor activation do?
Increased secretion of bronchial mucous, gastric acid, capillary permeability, mast cell activation, coronary, peripheral vasodilation, chronotropy and inotropy
What does serotonin do in type 1 reaction?
Bronchoconstriction
What do leukotrienes c4 d4 e4 do in type 1 reaction?
Bronchoconstriction
Increased capillary permeability
Vasodilation
Coronary vasoconstriction
Myocardial depression
What does Prostaglandin D2 do?
Vasodilation
bronchoconstriction
What does prostaglandin d2 do in type 1 reaction?
Vasodilation, bronchoconstriction
What does Thromboxane B2 do in type 1 reaction?
pulm. hypertension
increased capillary permeability
What does bradykinin do in type 1 reaction?
It vasodilates, bronchoconstricts, and you guessed it, increased capillary permeability.
Whatdoes platelet activating factor do in a type 1 reaction?
it aggregates and activates platelets, smooth muscle contraction and increased capillary permeability
When would you do the RAST or AlaSTAT latex test in patients?
ONLY for at risk groups
What are the at risk groups for latex allergy?
Fruits- Banana, Avocados, Chestnuts, Cherries, Kiwi, Pineapple, Peaches, Passionfruit
What would you do before admission of latex allergy pt?
Notify all departments night before case. Make first case of day. Remove latex equipment- allow room to lie quiet for one hour. Premedication NOT recommended.
What is dose of epi for hypotension, and for CV collapse in intraoperative anaphylaxis?
5-10mcg hypotensive
0.1-0.5mg IV titrated for CV collapse
What is secondary treatment for intraoperative anaphylaxis?
Diphenhydramine 0.5-1mg/kg
Epi infusion 0.05-0.1mcg/kg/min
Norepi gtt 0.05-0.1mcg/kg/min
Isoproterenol
Corticosteroids
Methylprednisolone
What are other secondary treatment medications for intraoperative anaphylaxis?
Albuterol
Aminophylline
NaHCO3
Describe management of pt post anaphylactic reaction
12hr minimum observation
Resp support, no ext. until edema resolved
Biphasic analphylaxis will occur in 20 percent of patients