Questions · Perioperative Anaphylaxis
7 questions, 0 approved. Approve them one at a time — a quiz shows nothing you have not.
Recall — derived from a kept point
Which agents accounted for most identified culprits in NAP6, and what was the estimated incidence of perioperative anaphylaxis?
Answer: Of 199 identified culprit agents, antibiotics accounted for 94, neuromuscular blocking agents 65, chlorhexidine 18 and Patent Blue dye 9. The estimated incidence was approximately 1 in 10,000 anaesthetics, though the authors note the true incidence may be around 70% higher because of reporting delays and incomplete data.
Antibiotics were the leading identified culprit in this audit, ahead of neuromuscular blocking agents. Teicoplanin was only 12% of antibiotic exposures but caused 38% of antibiotic-induced anaphylaxis.
Source claim: In NAP6 the distribution of 199 identified culprit agents included antibiotics (94), neuromuscular blocking agents (65), chlorhexidine (18) and Patent Blue dye (9), with an estimated incidence of approximately 1:10,000 anaesthetics. The estimated incidence was approximately 1:10,000 anaesthetics, though case exclusion because of reporting delays or incomplete data means true incidence might be approximately 70% higher; teicoplanin comprised 12% of antibiotic exposures but caused 38% of antibiotic-induced anaphylaxis.
NAP6, Br J Anaesth 2018
recall · CA-2 · phrased by llm
NAP6 found particular patient factors associated with poor outcome, and a characteristic cardiac arrest rhythm. What were they, and how should that change your management?
Answer: Poor outcomes were associated with higher ASA grade, obesity, and treatment with beta blockers or ACE inhibitors. Pulseless electrical activity was the usual type of cardiac arrest, often with bradycardia, and there were 10 deaths and 40 cardiac arrests among 266 reports. The implication for management is that you should expect PEA with bradycardia rather than a shockable rhythm, and that the audit found worse outcomes among patients on beta blockers or ACE inhibitors, among those with higher ASA grade, and among those with obesity.
NAP6 reports these as associations with poor outcome, not as a tested mechanism or treatment strategy. Expect PEA with bradycardia rather than a shockable rhythm.
Source claim: In NAP6 there were 10 deaths and 40 cardiac arrests, pulseless electrical activity was the usual type of cardiac arrest often with bradycardia, and poor outcomes were associated with increased ASA, obesity, beta blocker and angiotensin-converting enzyme inhibitor medication.
NAP6, Br J Anaesth 2018
recall · CA-3 · phrased by llm
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Open prompts
How does your plan change if the patient is not optimised?
open · CA-2 · phrased by derived
What is the physiology behind what we just did?
open · CA-2 · phrased by derived
Talk me through the trade-off you made there.
open · CA-2 · phrased by derived
What would make you abandon this plan and do something else?
open · CA-2 · phrased by derived
Questions only — nothing here asserts anything, which is why a model is allowed to phrase them. Where no model was reachable these are the level defaults.