Supplemental Online Lesson

Lesson S20: PreAnesthetic Assessment of the Patient Claiming Penicillin Allergy: Integrating SCIP Requirements

Registration Fee: $15.00
2.0 AMA PRA Category 1 Credits^TM
available until September, 2012

Review Date: July, 2011

REGISTRATION INFORMATION FOR SUPPLEMENTAL LESSONS:

Click on the link below to download and print the course material and post-test exam.  Register for the exam to enter your responses to receive CME credit.  There are ten questions in the examination and you must achieve a score of 80% or better to earn CME credit.  Following successful completion, your certificate will be immediately available online.  In addition, a historical record of  completed CME courses is maintained online in an individualized profile.  This includes copies of course certificates which can be printed at any time.

The registration fee for this course is $15.00

Physicians are provided with two opportunities to successfully complete the exam presented here. 

Software Requirements: Adobe Acrobat Reader and any standard Internet Browser.

Allergy to penicillin is commonly reported. However, most patients are found not to be allergic upon skin testing. Standard of care now requires that all patients receive preoperative antibiotic therapy, a task for which anesthesiologists are usually responsible. As such, anesthesiologists are required to possess the knowledge to choose an appropriate antibiotic, and avoid agents with higher cost and greater potential for adverse side effects.

CASE HISTORY

A 69-year-old female presented for left shoulder replacement. Past medical history was significant for mild seasonal allergies, well controlled by occasional use of an albuterol inhaler and hypertension treated with hydrochlorothiazide and amlodipine. She also had osteoarthritis for which she took a variety of non-steroidal anti-inflammatory agents. Surgical history included general anesthesia for tonsillectomy and placement of a myringotomy tube as a child. There were no known anesthetic related complications. She noted an allergy to penicillin based on an anecdotal report from her mother regarding a suspicious rash. She was 65 inches tall and weighed 174 lbs. Lung auscultation was clear bilaterally, with no evidence of rales, rhonchi or wheezing.

LEARNING OBJECTIVES

At the end of this activity, the participant should be able to:

1. State the relationship between the incidence of self-reported penicillin allergy and severe reaction to antibiotic administration.
2. State the objectives of the Surgical Care Improvement Program (SCIP).
3. Describe the immunologic mechanism responsible for the hypersensitivity reaction observed in penicillin allergic individuals.
4. Differentiate between the commonly prescribed classes of antibiotics.
5. Be aware of current recommendations for antimicrobial prophylaxis.
6. Identify alternative antibiotic selection for an individual with a reported allergy to penicillin.
7. List the possible reactions to penicillin that a patient may interpret as allergic.
8. Identify the indications for skin testing in determining penicillin allergy.
9. Be able to discuss Tips for Safer Surgery with patients.
10. Safely administer an appropriate prophylactic antibiotic.

TARGET AUDIENCE:  Anesthesiologists

Accreditation Statement

Mount Sinai School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation: The Mount Sinai School of Medicine designates each educational activity for a maximum of 2 AMA PRA Category 1 Credits^TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

It is the policy of Mount Sinai School of Medicine to ensure objectivity, balance, independence, and scientific rigor in all CME-sponsored educational activities. All faculty participating in the planning or implementation of a sponsored activity are expected to disclose to the audience any relevant financial relationships and to assist in resolving any conflict of interest that may arise from the relationship. Presenters must also make a meaningful disclosure to the audience of their discussions of unlabeled or unapproved drugs or devices.

Disclosures

The author, the reviewer, and the editor have no relation-ships with pharmaceutical companies or manufacturers of products to disclose. This educational activity may contain discussion of published and/or investigational uses of agents for the treatment of disease. Some uses of these agents have not been approved by the FDA. Please refer to the official prescribing information for each product for approved indications, contraindications, and warnings.

CONTACT INFORMATION

Questions regarding course content may be directed to Dr. Elizabeth Frost: ElzFrost@aol.com.

If you require technical assistance with completing this course, please contact Continuing Education Online Customer Service at 718-648-8080 or send e-mail to ceo.contact7@proceo.com.

CALL FOR WRITERS

If you would like to write a CME lesson in Anesthesiology News, please send an e-mail to Elizabeth A.M. Frost, MD, at ElzFrost@aol.com