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> | ||
==Physical Examination== | ==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. <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> | [[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]] | ||
*Piloerection | *[[Goose bumps|Piloerection]] | ||
*Warm feeling | *Warm feeling | ||
===Heart=== | ===Heart=== | ||
*Abnormal heart rhythm ([[arrhythmia]]) | *Abnormal heart rhythm ([[arrhythmia]]) | ||
*Palpitations | *[[Palpitations]] | ||
*Chest pain | *[[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]] | ||
*Rhinorrea | *[[Rhinorrhea|Rhinorrea]] | ||
*Dyspnea | *[[Dyspnea]] | ||
===Neurologic=== | ===Neurologic=== | ||
*Mental [[confusion]] | *Mental [[confusion]] | ||
*Dizziness | *Dizziness | ||
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===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 | ||
Revision as of 17:01, 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]
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. [2] [3] [4] [5] [6] [7]
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
- Rhinorrea
- Dyspnea
Neurologic
- Mental confusion
- Dizziness
- Syncope
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). - ↑ 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.