Immunological Emergencies

  1. Lymphatic and Immune System
    1. Major Components and Functions of the Lymphatic System
    2. Formation of Lymph Fluid
    3. Lymph Vessels and Return to the Blood
    4. Location and Function of Lymph Nodes and the Spleen
    5. Lymphocytes
    6. Immunity
      1. Antigens
      2. antibodies
    7. Innate Immunity
      1. Defensive cells
        1. Natural killer cells (NK cells)
        2. Basophils
        3. Mast cells
        4. Phagocytes
        5. Langerhans cells
      2. Chemical defenses
        1. Interferons
        2. Complement
        3. Inflammation
        4. Fever
    8. Adaptive Immunity
      1. Cell-mediated
      2. Antibody mediated
    9. Thymus
      1. Stem cells
      2. T lymphocytes – T cells
    10. Humoral immunity and Cell Mediated Immunity
    11. Development and Function of B Cells and T Cells
    12. Acquired Immunity and Genetic Immunity
    13. Vaccinations
    14. Classifications  of Microorganisms
    15. Distribution of and Benefits of Normal Flora
    16. Infectious Disease
      1. Methods by which infectious diseases are spread
    17. Characteristics of the immune response
    18. Characteristics of the immune response
      1. Natural versus acquired response
        1. Natural or native immunity
        2. Acquired immunity
          1. active acquired immunity
          2. passive acquired immunity
      2. Primary versus secondary immunity
        1. Primary or initial immune response
        2. Secondary or anamnesic immune response
      3. Humoral versus cell-mediated immunity
        1. B-cell lymphocyte
        2. T-cell lymphocyte
    19. Introduction of the immune response
      1. Antigens and immunogens
        1. Antigens
        2. Immunogen
        3. Tolerance
        4. Molecular size
          1. larger—protiens, polysaccharides, and nucleic acids
          2. smaller—amino acids, monosaccharides, and fatty acids
          3. haptens—smaller molecules which become immunogenic
      2. Histocompatibility antigens (HLA antigens)
        1. HLA complexes or major histocompatibility complexes (MHC)
        2. Role of HLA antigens
      3. Blood group antigens
        1. Rh system
        2. ABO system
    20. Humoral immune response
      1. B-cell lymphocytes
        1. Formation
          1. lymphoid stem cell
          2. generation of clonal diversity
          3. clonal selection
          4. activated B-cell
            1. immunoglobuliln-secreting plasma cells
            2. memory cells
      2. Immunoglobulins
        1. Differences between immunoglobulins and antibodies
        2. Structure of immunoglobulin molecules
        3. Function of antibodies
          1. agglutination
          2. precipitation
          3. neutralization
            1. bacterial toxins
            2. viruses
            3. opsonization of bacteria
            4. activation of inflammatory processes
            5. classes of immunoglobulins
            6. antibodies as antigens
          4. isotypic antigens
          5. allotypic antigens
          6. idiotypic antigenic determinants
        4. Monoclonal anitbodies
      3. Secretory immune system
        1. Mucusal-associated lymphoid tissue
          1. lacrimal glands
          2. salivary glands
          3. bronchial-associated lymphoid tissue
          4. mammary-associated lymphoid tissue
          5. gut-associated lymphoid tissue
          6. genital-associated lymphoid tissue
        2. Circulates independently of other lymphocytes
          1. mucosal-association lymphoid tissue
          2. regional lymph nodes
          3. thoracic duct
          4. blood
        3. First line of defense
        4. Local rather than systemically
    21. Cell-mediated immune response
      1. T-cells
        1. Five types of mature T-cells
          1. memory cells
          2. Td cells or lymphokine-producing cells
          3. Tc cells or cytotoxic cells
          4. Th cells or helper T-cells
          5. Ts cells or suppressor T-cells
        2. Proliferation and differentiation
      2. Major effects of cell-mediated immune response
        1. Cytotoxicity
        2. Delayed hypersensitivity
        3. Memory
        4. Control
    22. Cellular interactions in the immune response
      1. Cytokines
        1. Lymphokines
        2. Monokines
      2. Antigen processing, presentation, and recognition
        1. Antigen degradation
        2. Classes of histocompatible antigens (HLA)
        3. T-cell receptors
        4. Interleukin-1 (IL-1)
      3. T-cell and B-cell differentiation
        1. T-cell differentiation
        2. B-cell differentiation
        3. Control of B and T-cell development
    23. Fetal and neonatal immune function
      1. Fetal immunological capabilities
        1. Immunologic responses
        2. Antibody capabilities
      2. Antibody levels
        1. Umbilical cord blood
        2. Neonatal circulation
      3. Trophoblasts
    24. Aging and the immune response in elderly
      1. T-cell function
      2. Antibody production
      3. Autoimmune and isoimmune diseases
        1. Grave’s disease
        2. Rheumatoid arthritis
        3. Myasthenia gravis
        4. Immune thrombocytopenic purpura
        5. Isoimmune neutropenia
        6. Systemic lupus erythematosus (SLE)
        7. Rh and ABO isoimmunization
    25. Immunity and inflammation deficiencies
      1. Congenital immune deficiencies
      2. Acquired deficiencies
        1. Nutritional deficiencies
        2. Iatrogenic deficiencies
        3. Deficiencies caused by trauma
        4. Deficiencies caused by stress
        5. AIDS
      3. Replacement therapies for immune deficiencies
        1. Gamma globulin therapy
        2. Transplantation and transfusion
        3. Gene therapy
        4. Role of the immune system
          1. interaction of immune, nervous, and endocrine systems during a stress response
          2. influence of stress response on immune system
          3. relationship between stress and immune-related conditions and diseases
            1. cardiovascular
            2. muscles
            3. connective tissue
            4. pulmonary system
            5. immune system
            6. G.I. system
            7. G.U. system
            8. skin
            9. endocrine
            10. central nervous system
    26. Stress, coping, and illness interrelationships
      1. Stress as interdependent processes
        1. Definition of physiologic stress and psychologic distress
        2. Effects of psychologic distress
        3. Relationship between distress and immune dysfunction
      2. Potential stress effects on
        1. Healthy individuals
          1. ineffective coping
          2. effective coping
        2. Symptomatic individuals
          1. ineffective coping
          2. effective coping
        3. Medical interventions
          1. ineffective coping
          2. effective coping

I. Allergic reaction
       a. Hyperactive, localized immune response to an allergen
       b. Some histamine is released
       c. Localized: redness, swelling, hives, itching
       d. May cause nausea, vomiting, and/or diarrhea
       e. Usually requires minimal supportive therapies
       f. Repeat exposures may lead to anaphylaxis (e.g., insect stings, foods, etc.)
II. Anaphylaxis
       a. Multiple body systems are affected, not just a localized reaction like allergies
       b. Life threatening reaction of the immune system to an allergen
       c. Large quantities of histamine are released throughout the body
       d. Vasodilation and increased capillary permeability
       e. May lead to shock
       f. Bronchoconstriction and mucous production
       g. May lead to respiratory distress
              i. Soft tissue swelling of the upper airway
              ii. Airway obstructions
III. Treatment for Anaphylaxis
       a. Out-of-hospital treatment
              i. Ensure adequate airway, ventilation, and oxygenation
              ii. SpO2 <94% administer oxygen
              iii. Establish an IV or IO, administer fluids
              iv. Epinephrine
                     1. First line medication of choice
                            a. Reverses many of the effects of the histamine
                                   i. Bronchodilation
                                   ii. Vasoconstriction
                            b. Requires continuous reassessment
                            c. Consider additional dosing due to short half-life
              v. Diphenhydramine
                     1. Second line medication of choice
                            a. Blocks histamine receptors
                                   i. Inhibits further histamine response
              vi. Consider Albuterol (via nebulizer)
                     1. Bronchodilator

Content Creator: Joyce Lockwood
CAPCE Course Number: 19-EMTP-F3-1315
NJ Course Number: 141143
Total CE Hours: 1
Level: Basic
EMT-CE uses the NEMSES guidelines as the foundation for every course outline.