21.3 Emergencies- Anaphylactic shock

Question 1

What is an anaphylactic shock?

Answer 1

Type I Ige mediated hypersensitivty reaction. Release of histamine and other agents lead to the symptoms

Question 2

What are the symptoms of analphylactic shock?

Answer 2

Wheeze, cyanosis, oedema, urticaria

oedema, itching, sweating, diarrhoea and vomiting

Question 3

What are the first two stages in the management of anaphylaxis?

Answer 3

Secure the airway- give 100% oxygen. Intubate if respiratory obstruction imminent

Remove the causative agent. Raise the feet may help circualtion

Question 4

What role does adrenaline have to play in the recovery from anaphylaxis?

Answer 4

Give IM 0.5mg adrenaline every 5 minutes until BP, pulse, Respiratory function are deemed to be better

Question 5

What is paramount to make sure is accessed particularly in the early stages?

Answer 5

IV access

Question 6

What other drugs can be given apart from adrenaline?

Answer 6

Clorphenamine 10mg IV (antihistamine)

and hydrocortisone 200mg IV (croticosteroid)

Question 7

What should you do if the patient is still hypotensive despite adreanline, fluid resuscitation

Answer 7

ICU

IV adrenaline, aminophylinne, nebulised salbutamol

Question 8

What investigations should be carried out on the ward?

Answer 8

ECG
Serum tryptase levels (for 6 hours)
Skin prick tests for IgE allergens to avoid

Question 9

How should adrenaline be delivered?

Answer 9

IM not IV (unless severely ill or has no pulse)