Fatal Anaphylaxis: Mortality Rate and Risk Factors Essay
he treatment of anaphylactic shock varies depending on a patient’s physiological response to the alteration. Immediate medical intervention and emergency room visits are vital for some patients, while others can be treated through basic outpatient care. Consider the January 2012 report of a 6-year-old girl who went to her school nurse complaining of hives and shortness of breath. Since the school did not have any medication under her name to use for treatment and was not equipped to handle her condition, she was sent to an emergency room where she was pronounced dead. This situation has raised numerous questions about the progression of allergic reactions, how to treat students with severe allergies, how to treat students who develop allergic reactions for the first time, and the availability of epinephrine in schools. If you were the nurse at the girl’s school, how would you have handled the situation? How do you know when it is appropriate to treat patients yourself and when to refer them to emergency care? To Prepare Review “Anaphylactic Shock” in Chapter 24 of the Huether and McCance text, “Distributive Shock” in Chapter 10 of the McPhee and Hammer text, and the Jacobsen and Gratton article in the Learning Resources. Identify the multisystem physiologic progression that occurs in anaphylactic shock. Fatal Anaphylaxis: Mortality Rate and Risk Factors Essay. Think about how these multisystem events can occur in a very short period of time. Consider when you should refer patients to emergency care versus treating as an outpatient. Select two patient factors different from the one you selected in this week’s first Discussion: genetics, gender, ethnicity, age, or behavior. Reflect on how the factors you selected might impact the process of anaphylactic shock. By Day 4 Post an explanation of the physiological progression that occurs in anaphylactic shock. Then, describe the circumstances under which you would refer patients for emergency care versus treating as an outpatient. Finally, explain how the patient factors you selected might impact the process of anaphylactic shock.
Patho Discussion Week 5
Anaphylactic shock is a multisystem syndrome that occurs due an abrupt activation and release of mast cells along with the basophils within the circulation. The mast cells and basophils are activated when the immunoglobulin (Ig) E crosslink and after the buildup of the receptors for IgE, FcεRI. After their activation, they rapidly discharge preformed mediators such as histamine, proteoglycans, carboxypeptidase A, and tryptase. There is also production of metabolites such as platelet activating factor (PAF), prostaglandins and leukotrienes (Alberto et al, 2017). Fatal Anaphylaxis: Mortality Rate and Risk Factors Essay.
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Majority of the mediators mediate pathophysiology of anaphylaxis. For example, histamine rouses vasodilation, increase heart rate and heart contraction while prostaglandin D2 acts as a peripheral vasodilator, vasoconstrictor, and bronchoconstrictor. Generally, physiological changes in anaphylaxis involve vasodilatation and peripheral pooling that lead to hypovolemia resulting in impaired cellular metabolism and reduced tissue perfusion (Alberto et al, 2017).
All patients who fail to successfully respond to three doses of epinephrine (normally administered 5 -15 minutes apart) should have an immediate transfer to an emergency department. In addition, patients who experience mild generalized erythema on the skin and subcutaneous tissues can be treated as outpatients. However, patients who experience wheezing, dyspnea, dizziness, cardiovascular, or gastrointestinal involvement, hypoxemia, confusion, hypotension, or loss of consciousness or incontinence should be immediately be transferred to the emergency department (Ring et al, 2014).
Patient Factors that might impact Anaphylactic Shock Process
Age and ethnicity may influence the process of anaphylactic shock. Old age is associated with a more severe process of anaphylactic shock and higher fatality rates. The increased prevalence of anaphylactic shock with increased age can be allied to increased allergen exposure and increased cardiovascular susceptibility (Turner et al, 2017). In regard to ethnicity, studies have shown that African-American have higher vulnerability to anaphylactic shock when compared to whites within the U.S (Turner et al, 2017). Fatal Anaphylaxis: Mortality Rate and Risk Factors Essay.
Alberto A, Tanno L & Baeza M. (2017). How to manage anaphylaxis in primary care. Clin Transl Allergy. 7(45).
Ring J, Beyer K, Tilo B, Duda D, Hans M, Knut B, Varga E, Worm M et al. (2014). Guideline for acute therapy and management of anaphylaxis. Allergo J Int. 23(3), 96–112.
Turner P, Elina J, Lin R, Campbell D & Boyle R. (2017). Fatal Anaphylaxis: Mortality Rate and Risk Factors. J Allergy Clin Immunol Pract. 5(5), 1169–1178. Fatal Anaphylaxis: Mortality Rate and Risk Factors Essay.