D118 Unit 2 Lecture

Anaphylaxis

• Acute, life-threatening, systemic event associated with hypersensitivity reaction
• Manifestations occur across multiple organ systems:
  • Cardiovascular
  • Respiratory
  • Integumentary
  • Gastrointestinal
  • Central nervous systems
• Reactions can occur within seconds to 2 days after exposure
• Common potential allergens:
  • Listed in primary care textbook, page 183
• Anaphylactic reaction occurs due to:
  • Rapid release of immunoglobulin E
  • Immune hypersensitivity reaction
  • Activation of mast cells and basophils
  • Leading to potentially life-threatening upper or lower airway obstruction
• Clinical presentations may vary in severity:
  • Periodic rashes to severe systemic manifestations
• Diagnosis is based on:
  • Clinical presentation
  • History
  • Physical examination

Treatment of Anaphylaxis

• Epinephrine is the 1st line treatment
• Dosage for adults:
  • 1:1000 dilution, 1 mg/mL, 0.2-0.5 mg, repeated every 5-15 minutes, max dose 1 mg
• Dosage for children:
  • 1:1000 dilution, 1 mg/mL, 0.01 mg/kg, repeated every 5-20 minutes, max dose 0.3 mg
• Non-pharmacologic management:
  • Maintenance of airway, breathing, circulation, and level of consciousness

Bradycardia

• Defined as a heart rate of less than 60 beats per minute
• Types:
  • Absolute bradycardia
  • Relative bradycardia
• Causes:
  • Trauma
  • Hypovolemia
  • Infectious process
  • Drug toxicity
  • Electrolyte abnormality
  • Lyme disease
  • Transient injury to the conduction system
• Symptoms:
  • Dizziness
  • Fatigue
  • Syncope
• Diagnostic testing:
  • Glucose levels
  • Electrolyte values
  • Blood urea nitrogen (BUN) level
  • Creatinine concentration
  • Liver function tests
  • Complete blood count (CBC)
  • Thyroid panel
  • Chest X-ray
• Initial management:
  • Dependent on history and physical examination
  • Intervention not necessary if patient is stable and asymptomatic
  • Continued monitoring indicated for patient's wellbeing and safety

Bundle Branch Block

• Disruption of conduction as it moves down the bundle branches
• Causes:
  • Structural heart disease
  • Congenital conditions
  • Cardiac disease
  • Coronary artery disease
• Symptoms:
  • Similar to those discussed in previous slide
• Diagnostics:
  • 12-lead electrocardiogram
  • Halter monitor
  • Laboratory testing
  • Cardiac imaging
  • Stress test
• Management:
  • Focused on treatment of underlying cause
  • Treatment of symptoms

Otitis Media

• Characterized by fluid in the middle ear
• Associated with inflammatory or infective processes
• Bacterial positive agents:
  • Streptococcus pneumoniae
  • Hemophilus influenzae
• Infections can be caused by both bacteria and viruses
• Most common initial complaint:
  • Sudden onset of ear pain, worse in the prone position
• Diagnosis:
  • Examination of the inner ear
  • Tympanic membrane assessment
  • Webber and Ryan tests
• Management:
  • Based on each person's medical history, physical examination, and presentation
  • Initial observation includes a plan for treatment of associated symptoms
  • Pain management and planned provider contact within 24 hours for follow-up assessment

Hearing Loss

• Classified into 3 types:
  • Conductive
  • Sensorineural
  • Mixed
• Causes of sudden hearing loss in adults:
  • Sudden idiopathic sensorineural hearing loss
  • Infections
  • Perry lymphatic fistula
  • Schematic of the inner ear
  • Retrocochlear structures
  • Multiple sclerosis
  • Autoimmune diseases
  • Trauma
  • Chronic renal failure
  • Sickle cell anemia
• Gradual hearing loss:
  • Noise exposure
  • Familial factors
  • Retrocochlear neoplasm
  • Chronic hepatitis
  • Diabetes
  • Chronic renal failure
• Differential diagnosis:
  • Titus media
  • Perry lymphatic fistula
  • Monir disease
  • Multiple sclerosis
  • Autoimmune disorders

Vertigo

• Illusion of movement of oneself or the environment
• Causes:
  • Peripheral causes:
    • Benign paroxysmal positional vertigo
    • Vestibular nerve
    • Acute labyrinthitis
    • Ototoxicity
    • Head trauma
  • Central disorders:
    • Brainstem or cerebellar
    • Hemorrhage
    • Tumors
    • Multiple sclerosis
    • Migraine syndrome
• Associated symptoms:
  • Nausea
  • Vomiting
  • Diaphoresis
  • Disequilibrium
  • Sadness
  • Blurry vision
  • Ear symptoms (pain or pressure)
• Diagnostics:
  • Shown in image on slide

Pneumonia

• Leading cause of morbidity and mortality in the United States
• Community-acquired pneumonia:
  • Defined by the Infectious Diseases Society of America
  • Frequently associated with at least 2 symptoms of active infection
  • Occurs in individuals who have not been hospitalized or resided in a long-term care facility for 14 days before the onset of symptoms
• Hospital-acquired pneumonia:
  • Defined as pneumonia that occurs 48 hours or more after hospital admission
  • Did not appear to be incubating at the time of admission
• Health care-associated pneumonia:
  • Defined as pneumonia that occurs in a non-hospitalized patient
  • Has extensive health care contact
• Clinical presentation:
  • History of fever, chills, or rigors
  • Malaise
  • Cough with or without sputum production
• Older adults may show:
  • Fatigue
  • Lethargy
  • Decreased appetite
  • Increased falls
  • Mental status changes

H. Pylori

• Gram-negative bacteria
• Transmitted via the fecal-oral route in early childhood
• Causes both peptic and ulcers
• Primary risk factor in the development of gastric cancer
• Diagnostic tests:
  • Stool test
  • Urea breath test
  • Serology tests
• Treatment:
  • Discussed in d116
  • General guidelines for treatment shown on slide

Test your knowledge on halter monitor testing, cardiac imaging, stress tests, and bundle branch block conduction disruptions. Learn about the management of Brady, evaluation for coronary disease, and underlying causes of bundle branch block.