Questions and Answers
What is the primary purpose of consulting services in a subacute management scenario?
Which of the following considerations is important when counseling a pregnant patient?
What ethical issue might arise involving a patient who is a Jehovah’s Witness and refuses a blood transfusion?
In patient-centered communication, what is meant by 'meeting a patient where they are'?
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What is a critical aspect when discussing driving risks with patients post-ICD implantation or stroke?
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When treating anaphylaxis, what is the maximum dose of intramuscular epinephrine that should be administered?
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Which of the following medications is used as an adjunctive treatment in anaphylaxis?
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What is the route of administration for epinephrine in cases of severe anaphylaxis?
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For patients who are experiencing significant bronchoconstriction during anaphylaxis, which medication should be considered?
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What should be performed after the administration of epinephrine for anaphylaxis?
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What is the concentration of the epinephrine solution for intravenous administration?
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Which of the following is NOT a common trigger for anaphylaxis?
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What is the primary treatment for acute anaphylaxis?
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What must a capable patient understand regarding medical treatment?
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Who should be identified as a substitute decision maker if a patient is incapable?
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In the case of a conflict between substitute decision makers (SDMs), who is responsible for making the decision?
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What defines a common-law partner in the context of healthcare decision-making in Ontario?
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What is a key consideration when treating a patient who waives their autonomy regarding consent?
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What scenario might require a healthcare provider to consider informed consent more closely?
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When may capacity for consent fluctuate in a hospital setting?
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Which of the following scenarios does NOT involve issues of consent?
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What is the most suitable adjustment to improve oxygenation in a patient with respiratory failure?
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Why is increasing the FiO2 to 100% not recommended before optimizing PEEP?
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In what scenario would switching to volume control ventilation be acceptable?
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A patient is on nasal prongs with worsening hypoxemia. What represents a potential next step in management?
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What finding in the VBG suggests that the patient might need urgent intervention?
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Which of the following management options is considered for acute respiratory failure in a palliative care setting?
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What is the primary goal when adjusting ventilator settings in acute respiratory failure?
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Which management option is least likely to benefit a patient with severe hypoxemia from influenza?
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Which feature indicates a potential diagnosis of serotonin syndrome rather than neuroleptic malignant syndrome?
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In a patient with severe traumatic brain injury, which of the following steps should be taken given the findings of GCS 3 and no brainstem reflexes?
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What is the main reason that prevents the completion of DNC assessment in the patient after a severe TBI with an ocular injury?
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Which of the following is considered an accepted ancillary test in neuroprognostication?
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What should be noted about the timing for DNC assessment after a traumatic brain injury?
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Which of these factors is NOT appropriate for assessing brainstem reflexes?
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Why can’t SSEPs be used as an accepted ancillary test in DNC assessment?
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After a patient ingestion of drugs, what is the most critical action within 4 hours of ingestion?
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Study Notes
Anaphylaxis Overview
- Common triggers include food, medication, latex, and insect venom.
- Diagnosis requires clinical criteria fulfillment after exposure to an allergen.
Acute Treatment
-
IM Epinephrine:
- Administer 0.01 mg/kg (max 0.5 mg) intramuscularly.
- Repeat every 5-15 minutes as needed.
- Use 1:1000 solution (1 mg/mL) in the anterolateral thigh.
-
IV Epinephrine:
- Administer 0.05-0.1 mg IV over 5 minutes.
- Maintain continuous infusion of 2-10 mcg/min adjusted to blood pressure.
- IV solution at 1:10,000 concentration (0.1 mg/mL).
-
Adjunctive Medications:
- H1-Blocker: Ranitidine 50 mg IV every 8 hours as required.
- H2-Blocker: Diphenhydramine 25-50 mg IV every 4-6 hours as needed.
- Steroids: Methylprednisolone 125 mg IV every 6 hours as necessary.
- Glucagon for patients on beta-blockers.
- Salbutamol for bronchoconstriction signs.
- Vasopressors for persistent hypotension.
Discharge Plan
- Prescribe Epinephrine Autoinjector (0.3 mg IM) for emergencies.
- Implement an Anaphylaxis Action Plan including patient education and wearing a MedicAlert bracelet.
- Refer to an Allergist/Immunologist for further evaluation.
Patient-Centered Communication
- Emphasizes understanding socioeconomic and cultural health influences.
- Consent and capacity for treatment require the understanding of treatment nature and consequences.
Consent for Incapable Patients
- Identify a Substitute Decision Maker (SDM) following Ontario’s hierarchy:
- Power of Attorney for Personal Care
- Spouse, common-law partner, or partner
- Parents or adult children over 16
- Siblings and other family members
- Public Guardian and Trustee in case of conflict.
Ethical Considerations in Patient Scenarios
- Considerations include managing patient decisions regarding life-saving therapy, communication of serious diagnoses, and potential family disagreements on treatment choices.
Additional Topics
- Non-Invasive Ventilation indicated for hypoxemia in specific cases; consider situations like respiratory failure or pneumonia.
- For severe traumatic brain injury, guidelines are to assess neurologic criteria following proper timelines, avoiding unnecessary delays.
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Description
This quiz covers essential information about anaphylaxis, including common triggers such as food, medication, and insect venom. It emphasizes the acute treatment protocols including the use of IM epinephrine and the importance of identifying and removing triggers. Test your knowledge on diagnosing and managing anaphylaxis.
