Anaphylaxis physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Patients with anaphylaxis usually appear flushed. Physical examination of patients with anaphylaxis is usually remarkable for swollen lips or other areas, wheezing, cyanosis, and low blood pressure. It is vital for the physician to assess cardiac and respiratory symptoms for any compromise as soon as possible. <ref name="pmidhttps://doi.org/10.1016/S0091-6749(18)30572-4">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1016/S0091-6749(18)30572-4 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }} </ref> | [[Patient|Patients]] with [[anaphylaxis]] usually appear [[flushed]]. [[Physical examination]] of [[Patient|patients]] with [[anaphylaxis]] is usually remarkable for swollen [[lips]] or other areas, [[Wheeze|wheezing]], [[cyanosis]], and [[Hypotension|low blood pressure]]. It is vital for the [[physician]] to assess [[Heart|cardiac]] and [[respiratory]] symptoms for any compromise as soon as possible. <ref name="pmidhttps://doi.org/10.1016/S0091-6749(18)30572-4">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1016/S0091-6749(18)30572-4 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }} </ref> | ||
The [[diagnosis]] is likely when any one of the following [[criteria]] is met: <ref name="pmid21293765">{{cite journal| author=Bjornsson HM, Graffeo CS| title=Improving diagnostic accuracy of anaphylaxis in the acute care setting. | journal=West J Emerg Med | year= 2010 | volume= 11 | issue= 5 | pages= 456-61 | pmid=21293765 | doi= | pmc=3027438 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21293765 }} </ref> | |||
*1. [[Acute (medicine)|Acute]] onset with involvement of [[Mucous membrane|mucosal]] tissue, [[skin]], or both and one of the following: | |||
**[[Respiratory Physiology|Respiratory]] compromise | |||
**[[Hypotension|Reduced blood pressure]] or evidence of [[end-organ dysfunction]] | |||
*2. Exposure to a likely [[antigen]] for the patient followed by two of the following: | |||
**[[Skin]] involvement | |||
**[[Respiratory]] compromise | |||
**[[Hypotension|Reduced blood pressure]] | |||
**[[Gastrointestinal tract|Gastrointestinal]] symptoms | |||
*3. Exposure to a known [[allergen]] to the patient followed by [[Hypotension|reduced blood pressure]] | |||
==Physical Examination== | ==Physical Examination== | ||
Physical examination of patients with anaphylaxis is usually remarkable for flushing and pruritis. <ref name="pmiddoi: 10.1016/S1081-1206(10)61367-1.">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=doi: 10.1016/S1081-1206(10)61367-1. | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }} </ref>. | [[Physical examination]] of [[patients]] with [[anaphylaxis]] is usually remarkable for [[flushing]] and [[pruritis]]. The presentation can vary for [[patients]] and it is important not to delay [[treatment]]. <ref name="pmiddoi: 10.1016/S1081-1206(10)61367-1.">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=doi: 10.1016/S1081-1206(10)61367-1. | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }} </ref> <ref name="pmidhttps://doi.org/10.1186/s13223-018-0283-4">{{cite journal| author=Schmoldt A, Benthe HF, Haberland G| title=Digitoxin metabolism by rat liver microsomes. | journal=Biochem Pharmacol | year= 1975 | volume= 24 | issue= 17 | pages= 1639-41 | pmid=https://doi.org/10.1186/s13223-018-0283-4 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10 }} </ref> <ref name="pmid20584005">{{cite journal| author=Waserman S, Chad Z, Francoeur MJ, Small P, Stark D, Vander Leek TK | display-authors=etal| title=Management of anaphylaxis in primary care: Canadian expert consensus recommendations. | journal=Allergy | year= 2010 | volume= 65 | issue= 9 | pages= 1082-92 | pmid=20584005 | doi=10.1111/j.1398-9995.2010.02418.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20584005 }} </ref> <ref name="pmid20176258">{{cite journal| author=Simons FE| title=Anaphylaxis. | journal=J Allergy Clin Immunol | year= 2010 | volume= 125 | issue= 2 Suppl 2 | pages= S161-81 | pmid=20176258 | doi=10.1016/j.jaci.2009.12.981 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20176258 }} </ref> <ref name="pmid21377030">{{cite journal| author=Simons FE, Ardusso LR, Bilò MB, El-Gamal YM, Ledford DK, Ring J | display-authors=etal| title=World Allergy Organization anaphylaxis guidelines: summary. | journal=J Allergy Clin Immunol | year= 2011 | volume= 127 | issue= 3 | pages= 587-93.e1-22 | pmid=21377030 | doi=10.1016/j.jaci.2011.01.038 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21377030 }} </ref> <ref name="pmid16948628">{{cite journal| author=Brown SG, Mullins RJ, Gold MS| title=Anaphylaxis: diagnosis and management. | journal=Med J Aust | year= 2006 | volume= 185 | issue= 5 | pages= 283-9 | pmid=16948628 | doi=10.5694/j.1326-5377.2006.tb00619.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16948628 }} </ref> | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patients with anaphylaxis usually appear flushed with swollen areas. | |||
*Patients with [[anaphylaxis]] usually appear [[flushed]] with swollen areas. | |||
===Vital Signs=== | ===Vital Signs=== | ||
*[[Hypotension|Low blood pressure]] | *[[Hypotension|Low blood pressure]] | ||
*Rapid [[pulse]] or tachycardia | *Rapid [[pulse]] or [[tachycardia]] | ||
===Skin=== | ===Skin=== | ||
*[[Hives]] | *[[Hives]] | ||
*Skin that is blue from lack of oxygen or pale from shock | *Skin that is blue from lack of oxygen or pale from shock | ||
*Eczema | *[[Eczema]] | ||
*[[Goose bumps|Piloerection]] | |||
*Warm feeling | |||
===Heart=== | ===Heart=== | ||
*Abnormal heart rhythm ([[arrhythmia]]) | *Abnormal heart rhythm ([[arrhythmia]]) | ||
*[[Palpitations]] | |||
*[[Chest pain]] | |||
===Lungs=== | ===Lungs=== | ||
*[[Wheezing]] | *[[Wheezing]] | ||
*Fluid in the lungs ([[pulmonary edema]]) | *Fluid in the lungs ([[pulmonary edema]]) | ||
*Nasal congestion | *[[Nasal congestion]] | ||
*Sneezing | *[[Sneezing]] | ||
*Cough | *[[Cough]] | ||
*Hoarseness | *[[Hoarseness]] | ||
*[[Rhinorrhea|Rhinorrhea]] | |||
*[[Dyspnea]] | |||
===Neurologic=== | ===Neurologic=== | ||
*Mental [[confusion]] | *Mental [[confusion]] | ||
*Dizziness | *[[Dizziness]] | ||
*Syncope | *[[Syncope]] | ||
===Other=== | ===Other=== | ||
*Swelling ([[angioedema]]) in the throat that may be severe enough to block the [[airway]] | *Swelling ([[angioedema]]) in the throat that may be severe enough to block the [[airway]] | ||
*Swelling of the eyes or face | *[[Swelling]] of the eyes or face | ||
*Weakness | *[[Weakness]] | ||
*Nausea or vomiting | *[[Nausea and vomiting|Nausea or vomiting]] | ||
*Abdominal pain | *[[Abdominal pain]] | ||
*Diarrhea | *[[Diarrhea]] | ||
*Anxiety | *[[Anxiety]] | ||
The health care provider will wait to test for the specific allergen that caused anaphylaxis (if the cause is not obvious) until after treatment. | The health care provider will wait to test for the specific [[allergen]] that caused [[anaphylaxis]] (if the cause is not obvious) until after treatment. | ||
==References== | ==References== | ||
Latest revision as of 18:03, 14 April 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: Dushka Riaz, MD
Overview
Patients with anaphylaxis usually appear flushed. Physical examination of patients with anaphylaxis is usually remarkable for swollen lips or other areas, wheezing, cyanosis, and low blood pressure. It is vital for the physician to assess cardiac and respiratory symptoms for any compromise as soon as possible. [1]
The diagnosis is likely when any one of the following criteria is met: [2]
- 1. Acute onset with involvement of mucosal tissue, skin, or both and one of the following:
- Respiratory compromise
- Reduced blood pressure or evidence of end-organ dysfunction
- 2. Exposure to a likely antigen for the patient followed by two of the following:
- Skin involvement
- Respiratory compromise
- Reduced blood pressure
- Gastrointestinal symptoms
- 3. Exposure to a known allergen to the patient followed by reduced blood pressure
Physical Examination
Physical examination of patients with anaphylaxis is usually remarkable for flushing and pruritis. The presentation can vary for patients and it is important not to delay treatment. [3] [4] [5] [6] [7] [8]
Appearance of the Patient
- Patients with anaphylaxis usually appear flushed with swollen areas.
Vital Signs
- Low blood pressure
- Rapid pulse or tachycardia
Skin
- Hives
- Skin that is blue from lack of oxygen or pale from shock
- Eczema
- Piloerection
- Warm feeling
Heart
- Abnormal heart rhythm (arrhythmia)
- Palpitations
- Chest pain
Lungs
- Wheezing
- Fluid in the lungs (pulmonary edema)
- Nasal congestion
- Sneezing
- Cough
- Hoarseness
- Rhinorrhea
- Dyspnea
Neurologic
Other
- Swelling (angioedema) in the throat that may be severe enough to block the airway
- Swelling of the eyes or face
- Weakness
- Nausea or vomiting
- Abdominal pain
- Diarrhea
- Anxiety
The health care provider will wait to test for the specific allergen that caused anaphylaxis (if the cause is not obvious) until after treatment.
References
- ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID https://doi.org/10.1016/S0091-6749(18)30572-4 Check
|pmid=value (help). - ↑ Bjornsson HM, Graffeo CS (2010). "Improving diagnostic accuracy of anaphylaxis in the acute care setting". West J Emerg Med. 11 (5): 456–61. PMC 3027438. PMID 21293765.
- ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID 10.1016/S1081-1206(10)61367-1. doi: 10.1016/S1081-1206(10)61367-1. Check
|pmid=value (help). - ↑ Schmoldt A, Benthe HF, Haberland G (1975). "Digitoxin metabolism by rat liver microsomes". Biochem Pharmacol. 24 (17): 1639–41. PMID https://doi.org/10.1186/s13223-018-0283-4 Check
|pmid=value (help). - ↑ Waserman S, Chad Z, Francoeur MJ, Small P, Stark D, Vander Leek TK; et al. (2010). "Management of anaphylaxis in primary care: Canadian expert consensus recommendations". Allergy. 65 (9): 1082–92. doi:10.1111/j.1398-9995.2010.02418.x. PMID 20584005.
- ↑ Simons FE (2010). "Anaphylaxis". J Allergy Clin Immunol. 125 (2 Suppl 2): S161–81. doi:10.1016/j.jaci.2009.12.981. PMID 20176258.
- ↑ Simons FE, Ardusso LR, Bilò MB, El-Gamal YM, Ledford DK, Ring J; et al. (2011). "World Allergy Organization anaphylaxis guidelines: summary". J Allergy Clin Immunol. 127 (3): 587-93.e1-22. doi:10.1016/j.jaci.2011.01.038. PMID 21377030.
- ↑ Brown SG, Mullins RJ, Gold MS (2006). "Anaphylaxis: diagnosis and management". Med J Aust. 185 (5): 283–9. doi:10.5694/j.1326-5377.2006.tb00619.x. PMID 16948628.