Allergic Reactions

Allergic Reactions is a topic covered in the Pocket ICU Management.

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First Things First (assess & treat for the following)

  • Does pt have respiratory problems that require emergent attention?
    • Non-intubated pt seeking the "tripod" position
    • Stridor, hoarseness, drooling, difficulty swallowing
    • Tachypnea, labored respiration
    • Acidosis, hypoxia, relative hypercarbia
    • Wheezing, decreased breath sounds, shortness of breath
  • Does pt have evidence of circulatory shock?
    • Systolic BP < 90 mmHg, heart rate >100/min
    • Mottled skin, delayed capillary fill, weak pulses
    • Altered mental status, seizures
  • Does pt have new skin findings?
    • Angioedema of tongue, uvula, face (lips, periorbital) or neck
    • Urticaria anywhere on body
  • Does pt have new GI complaints such as nausea, vomiting, abdominal pain or diarrhea?

Contact dermatitis: inflammation of skin by agent(s).

  • Two major classes:
    • Irritant contact dermatitis such as concentrated acid or base
      • Common irritants in ICU: soaps, detergents, chronic wetness
      • Time of onset: immediately after exposure
      • Location: typically limited to directly exposed areas
      • Appearance: erythema, edema, vesicles & ulcers
    • Allergic contact dermatitis:
      • Common cause is plant exposure (poison ivy); others include preservatives in topical meds, nickel sulfate, formaldehyde, many others possible.
      • Time of onset: often 24-72 hrs after exposure (requires prior sensitization)
      • Location: areas exposed to direct contact
      • Appearance: linear w/ erythema & vesicles (often w/ intense itching)

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Last updated: April 20, 2010