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Immunology Anatomy, Allergic and Anaphylaxis, Anaphylactoid reactions, Collagen Vascular disease, and transplanted related problems, communicable disease Immune System Terms ◦ Immune system-the body system responsible for combating infection Immune response-complex cascade of events that works towards the destruction of pathogens or abnormal cells. ◦ Antigens-a marker on the surface of cell that identifies it as “self” or “non-self” ◦ Antibody-a substance produced by B lymphocytes in response to the presence of a foreign antigen that will combine with and control the antigen, thus preventing infection ◦ Immunity-a long term condition of protection from infection or disease Immunity types Natural VS. Acquired ◦ -Natural=not part of the immune response, inborn part of your genetic make-up ◦ -Acquired=develops as an outcome of the immune response Passive-transferred to a person from outside source. Active-generated by the immune response after exposure to a antigen Immunity types Humoral VS. Cell-Mediated ◦ Lymphocytes WBC Recognizing foreign antigens Producing Antibodies Developing Memory ◦ B&T Lymphocytes B-Do not attack Antigens directly produce antibodies-confer long term immunity=Humoral T-Attack antigens directly=Cell-Mediated Humoral Immunity Basically a chemical attack of an invading substance ◦ Basic fighter=Antibodies AKA=IMMUNOGLOBINS Speclized Cells (B-Cells) 5 types IgA IgD IgE-most important for allergic reactions IgG IgM Humoral Response Primary-Never exposed to antigen before. ◦ Antigen enters body Body respond by producing Antibodies Specifically IgE ◦ Antibodies remain The patient is primed for another exposure to that antigen THIS IS SENSITZATION Secondary- the body remembers Antigen and attacks it quickly Allergy Initial exposure of antigen is referred to as sensitization ◦ Subsequent exposure induce a faster and stronger response Some individuals become HYPERSENSITIVE to particular antigens ◦ Unexpected and exaggerated reaction to a particular antigen. Used synonymously with allergy. Hypersensitive Two types ◦ Delayed No cellular immunity Hours and days following-skin rash Example-Poison Ivy ◦ Immediate Large quantaties of IgE Antigen that does this is referred to as Allergen Allergen can enter the body through various routes Large majority of Anaphylactic reaction result from injection or envenomation Anaphylaxis An exaggerated allergic reaction to a foreign protein or other substance Common substances ◦ ◦ ◦ ◦ PCN Insect stings Radio-contrast dye Food-peanuts/shellfish Systems effected ◦ ◦ ◦ ◦ Cardiac Respiratory GI Skin Anaphylaxis Antigen introduced IgE bind to Mast/Basophillis cells IgE binds to the antigen and Mast Degranulate • Degranulation is the process of releasing chemicals from the cell Histamine, heparin and other mediators are release • Histamine is the main chemical mediator Anaphylaxis Histamine Effects Increased Capillary Permeability Vasodilation Bronchoconstriction Increased Mucus secreation Two classes ◦ H1-cause bronchoconstriction and GI contraction. ◦ H2-cause peripheral vasodilation and increased capillary permeability SRS-bronchoconstiction/potentiates Histamine Anaphylaxis Anaphylactic S/SX Generalized ◦ Itchy, watery, red eyes ◦ Runny nose CNS ◦ ◦ ◦ ◦ Anxiety/restlessness Confusion HA SZR Skin ◦ ◦ ◦ ◦ Itching and tingling Uticara(hives) Flushed or red skin Swelling of the hands or face S/SX Respiratory ◦ Chest and throat tightness ◦ Increase RR/Labored breathing ◦ Stridor, Hoarness Cardio ◦ Tachycardia ◦ Hypotension ◦ Weak pulses GI ◦ N/V ◦ Diarrhea ◦ Cramping Hives Angioneurotic edema Treatments Mild/Moderate/Severe Airway(monitor for horseness, edema, stridor) 02,,EKG BVM prn IV fluids maintain >90 BP EPI 0.3mg SQ/0.1-0.3mg SIVP Benadrly 50mg Solu-medrol 125mg Albuterol/Atrovent 2.5-5mg/.5mg EPINEPHRINE NamesActions-Adrenergic stimulant A&B receptors. Increased HR, Cardiac contractile force, vasoconstriction Indications-Anaphylaxis/Hives ◦ Dosage 1:1000/0.3mg/SQ adult .01mg/kg pediatric SQ 1:10000/0.1-0.3mg/SIVP Contraindications/Precautions-Patients with underlying heart disease. Those in profound anphylaxis may be peripheral vasoconstricted so SubQ epi may not work Diphenhydramine Names-Benadryl Actions-antihistamine blocks both H1 and H2 receptors Indications-Anaphylaxis/allergic/dsytonic reactions ◦ Dosage-25-50 mg SIVP or IM Contraindications-not used in asthma. In severe cases be sure to use EPI first. Can cause hypotension, HA, palpitations SOLUMEDROL Names-Methylprednisone Actions-steriod with anti-inflammatory properties Indications-Severe Anaphylaxis Dosage and routes-125 to 250mg IV or IM Contraindications/Precautions-None for anaphylaxis. One dose for patients. Albuterol Names-Proventil, ventolin Action-Cause bronchodilation strong b2 properties with minimal side effects Indications-Asthma, Anaphylaxis Dosage/routes-2.5-5mg Neb Contraindication/Precautions-Can cause palpitations, anxiety, dizziness, HA, nervousness. Atrovent Names-Ipratropium Action-Anticholinergic, bronchodilator. Dries respiratory secreations Indications-Asthma, Anaphylaxis Dosage/routes-.5mg NEB Contraindication/Precautions-few interactions with other meds. Breathing treatment should behind EPI and Benadryl with Anaphylaxis IM and SQ injections Anaphylactoid Reactions No previous Antigen exposure Not the typical Antigen-Antibody exposure The substance that the patient is taking in, is causing the breakdown of basophilis and mast cells First time exposure may present as a Anaphylactic reaction Anaphylactoid Common susbstances ◦ ◦ ◦ ◦ NSAIDS ASA Opiates Thiamine Collagen Vascular Disease Collagen vascular disease occurs when problems with the immune system affect collagen ◦ Collagen is a tough strong protein that comprises most of the body’s connective tissue Fibroblast-specialized cells that form collagen In a class of diseases known as autoimmune disorders, the body's immune system attacks its own tissues Examples of CVD Systemic lupus erythematosus (SLE) – inflammation of the connective tissues, can afflict every organ system. It is more common in women than men. Rheumatoid arthritis – a systemic disorder in which immune cells attack and inflame the membrane around joints. It also can affect the heart, lungs, and eyes. Scleroderma – activation of immune cells that produces scar tissue in the skin, internal organs, and small blood vessels. Sjögren's syndrome – aka Sjögren's disease, is a chronic, slowly progressing inability to secrete saliva and tears. It can occur alone or with rheumatoid arthritis, scleroderma, or systemic lupus erythematosus. Transplant related Problems Organs that can be transplanted are the heart, kidneys, liver, lungs, pancreas, intestine, and thymus. Tissues include bones, tendons (both referred to as musculoskeletal grafts), cornea, skin, heart valves, and veins. Worldwide, the kidneys are the most commonly transplanted organs, followed closely by the liver and then the heart. The cornea and musculoskeletal grafts are the most commonly transplanted tissues; these outnumber organ transplants by more than tenfold. Problems Transplant rejection occurs when transplanted tissue is rejected by the recipient's immune system, which destroys the transplanted tissue. ◦ Less by matching donors and immunospressive drugs Rejection categories include Hyperacute, Acute and Chronic TB What is it? How is it spread? ◦ Does everyone act as carrier? What are the Signs and SX? How to Protect yourself? Pertussis (Whooping Cough) What is it? How is it spread? ◦ Does everyone act as carrier? ◦ Does the Vaccine last for a lifetime? What are the Signs and SX? How to Protect yourself? Ebola What is it? How is it spread? ◦ Does everyone act as carrier? What are the Signs and SX? How to Protect yourself Ebola Checklist http://www.cdc.gov/vhf/ebola/pdf/emschecklist-ebola-preparedness.pdf Ohio DHS Handouts THE END