Acute Renal Failure
Rationale: Acute renal failure is a devastating form of anaphylactic reaction in which the kidneys cease to function. As a medical reaction, this has been known to happen when a patient has been administered an x-ray contrast media for visualization of the kidneys. As a medical assistant, you may be on site when a procedure like this is being performed, and may even be responsible for aftercare instructions. So, it is crucial that you understand what to look for post-examination. This reaction isn’t typically a rapid one; it can sometimes take as long as 48 hours to appear. The symptoms will include decreased urine output or anuria. The treatment phase following diagnosis of acute renal failure will include the use of a diuretic such as lasix, administration of fluids, and the possible need for dialysis.
Rationale: Vasomotor reactions are not true reactions in the sense that they are created in the mind. They are often brought on by a patient’s anxiety or fear of a situation or agent. Some patients have an unofficial condition referred to as Lab Coat Syndrome. This develops when patients enter any medical facility. The patient’s heart rate and blood pressure tend to rise, and they can even begin feeling nauseous and light-headed. Other reactions in this category include syncope and possible mild hives. Treatment is taking measures to allow the patient to relax themselves. Have the patient take deep breaths to slow down their heart and respiratory rate. Give them a cold compress for their forehead if they are feeling hot or nauseous. Have the patient lie back on the medical table, and monitor them until they are feeling better.
Rationale: The vasovagal reaction is an immediate life-threatening condition that should be considered a code alert if observed. The body has reacted in such a way that the involuntary nervous system has sent a signal to the body requiring it to slow down the heart rate, and widen the vessels leading to the legs, which in turn demands a drop in blood pressure, which in turn reduces the oxygen that can get to the brain. Blood pressure drops so that systolic is below 80 mmHg, and heart rate will fall dangerously low to below 50 bpm. This should be considered an emergency situation, and the crash cart should be grabbed immediately. In this situation, do NOT leave the patient unattended, check for a pulse immediately, and maintain monitoring of vital signs constantly.
Rationale: Anaphylaxis (Anaphylactic Reactions) is a result of an agent being introduced to the body that has caused the body to react in such a way that it becomes life-threatening. This is considered a true allergic reaction, unlike the vasomotor reaction. The agent can be chemical, natural, animal (animal bite or bee sting), or medicinal. Patient receiving a drug for the first time may react negatively. X-ray contrast media (incorrectly called x-ray dye) can cause allergic reactions in patients as well. Anaphylaxis must be treated immediately, or it can lead to a fatality. Reactions include urticaria, laryngospasms, bronchospasms, angioedema, extreme drop in blood pressure, and a rapid heart rate. Fast treatment can usually reverse the effects quickly, which makes reacting to the symptom with haste absolutely critical.
Rationale: Anuria is the complete loss of urine production in the kidneys. If the kidneys cease to function, they can halt the process of cleansing the blood from pollutants that should be released from the body in the form of urine. This is an emergency situation if diagnosed. This can happen as a result of an allergic reaction to x-ray contrast media (improperly referred to as x-ray dye). When contrast media enters the body, it follows the same route that a drug would when administered intravenously. It typically begins in the veins of the arm, where it flows until it enters the heart, is sent back out thru the arteries, which takes the blood directly into the kidneys. Immediate fluid rebalancing should be administered, and depending on the situation, perhaps emergency dialysis.
Rationale: In situations where a patient may be experiencing high heart rate or inconsistent blood pressure, they may begin to feel lightheaded. Orthostatic hypotension is the term to describe this period of light-headedness. People can feel this sensation if they stand up too quickly. This generally resolves itself rapidly. However, if someone does not regain their wits, and ends up passing out, this is known as syncope. This is the loss of consciousness that can result from a number of different reasons. Most episodes of syncope are for the most part harmless. However, it can a prelude to something larger, and should be properly documented.
Rationale: Urticaria is the official medical term for hives. Urticaria is a reaction that occurs to the body when mast cells release histamines into the internal environment. Histamines allow the body to react by causing fluid to leak from the local blood vessels. This leads to the tell-tale swelling of the skin, which is what we see as the external sign of hives. Hives are generally smooth in texture, but they can be combined into areas that make parts of the body appear like they are swollen. Patients usually experience itching and sometimes pain when hives appear. Hives generally do not last longer than 24 hours, but can last as long as a few weeks before disappearing.
Rationale: Angioedema is an extreme form of urticaria. This is a medical emergency that can cause difficulties breathing and in extreme situations can cause the airway to be closed completely. However, instead of the wheals that appear on the surface of the skin, this reaction happens in the deeper tissues of the body. Angioedema affects the dermis, subcutaneous tissue, mucosal and the submucosal tissues. The visual representation of this condition is generally seen in the areas of the face, but can be seen in the hands as well. When there is swelling of the areas surrounding the eyes, it is referred to as chemosis. When it appears in the areas of the mouth, the tongue will swell up in a matter of minutes. Other symptoms can include abdominal pain and cramping.
Rationale: A laryngospasm is one of a number of possible reactions that can occur during anaphylaxis. Of the possible reactions, this one is typically short-lived. The reaction itself only lasts about one minute in duration. The area of the larynx resides just superior to the trachea. If the trachea senses that moisture, mucous, or blood has entered its cavity, a reaction occurs that forces the larynx to contract uncontrollably. This can be a reaction through normal eating and drinking, this can also be as a result of an allergic reaction to a medication. In the typical, mild spasm, it will resolve quickly. However, more desperate situations may require that the patient become intubated.
Rationale: Blood pressure (BP) is comprised of two separate readings. They are called systolic (first number) and diastolic (second number). Systolic readings are a measurement of the left ventricle pushing blood into the arterial network. The diastolic reading is an indication of the ability for that arterial network to accept the blood being pumped into it. The normal blood pressure reading for an adult is 120/80 mmHg (mmHg stands for millimeters of Mercury). The systolic number can measure between 95-120 mmHg and still be considered normal. Diastolic pressure can be considered normal within the range of 60-80 mmHg. If the blood pressure is in a range of 120-139/80-89 mmHg, it is considered pre-hypertension. Stage 1 hypertension begins when the range of 140-159/90-99 mmHg is met. Stage 2 hypertension is the most severe, and it is set at 160/100 mmHg and higher. Hypotension begins when the blood pressure falls below 95/60 mmHg.