Adult Anaphylaxis

Question 1

Define Anaphylaxis

Answer 1

Severe, potentially life-threatening systemic hypersensitivity reaction

Question 2

Care objectives for Anaphylaxis CPG

Answer 2

• Adrenaline IM with minimal delay
• Airway and perfusion support
• Hospital based observation (usually 4 hr) at a minimum

Question 3

Anaphylaxis Criteria

Answer 3

Sudden onset of symptoms (usually <30 min but up to 4 hours
AND
2 or more of RASH +/- confirmed exposure to an Antigen

Question 4

Additional Reminder for Anaphylaxis

Answer 4

• STOP the trigger
• Any patient with anaphylaxis (including resolved or possible anaphylaxis) or any patient that has received adrenaline for any reason must be transported as per CPG clinical red flags
• Patients require continuous monitoring as sudden deterioration can occur

Question 5

IM Adrenaline Adult Doses in Anaphylaxis

Answer 5

500mcg IM
Repeat @5/60 intervals as required

Question 6

When to request MICA in Anaphylaxis

Answer 6

If presenting with risk factors OR not responsive to initial Adrenaline.

Question 7

Risk Factors for Anaphylaxis

Answer 7

• Hx of refractory or ICU.
• Hypotensive BP <90
• Medication as precipitating cause
• Respiratory symptoms / respiratory distress
• History of asthma or multiple co-morbidities/medications.

Question 8

Initial Mx for Anaphylaxis

Answer 8

IM Adrenaline
Request MICA
Insert IV
O2 10-15L NRB

Question 9

Additional Therapies in Anaphylaxis

Answer 9

Airway Oedema: Adrenaline Nebulised.
Bronchospasm: Salbutamol + Ipratropium Bromide + Dexamethasone.
Cardiovascular/Hypotension: Fluids
Beta Blocked/CCF: Glucagon

Question 10

Airway Oedema/Stridor - Anaphylaxis

Answer 10

Adrenaline 5mg Nebulised
- Consult for repeat doses
- Notify receiving hospital

Question 11

Bronchospasm in Anaphylaxis

Answer 11

• Salbutamol 5mg nebulised or 4-12 pMDI (repeat at 20 minutely)
• Ipratropium Bromide 500 mcg nebulised or 8 pMDI (no repeat)
• Dexamethasone 8 mg IV/0

Question 12

Glucagon Mx in Anaphylaxis

Answer 12

If inadequate response to Adrenaline with history of heart failure OR taking Beta Blockers:
- Glucagon 1mg IV / IM
- Repeat dose @5/60

Question 13

Additional therapy notes

Answer 13

• Adrenaline IS the ABSOLUTE priority
• Additional therapies should be run concurrent and should not delay adrenaline
• If bronchospasm persists despite adrenaline administration commence bronchospasm therapy
• Where hypotension (>90SBP) persists despite adrenaline IV fluid may be required to support Vasopressor administration
• Glucagon has an Inotropic, chronotropic and antibronchospastic effects and is indicated in pts who remain hypotensive after X2 doses of adrenaline in the setting of
  - Px heart failure OR taking beta blockers
• Glucagon must not delay adrenaline administration

Question 14

Adrenaline Notes in Anaphylaxis

Answer 14

• IM Adrenaline is the primary treatment for anaphylaxis.
• IM Site: Anterolateral mid-thigh.
• Adrenaline Infusion: where ……….

Question 15

Define inotropic, chronotropic

Answer 15

• Inotropic effects, increasing the strength of the muscle contractions (ventricles).
• Chronotropic effects, increasing the rate or timing of physiological effect such as HR

Question 16

Management Plan notes

Answer 16

Many Pts presenting with anaphylaxis will be under a medical specialist’s care and will have a prescribed anaphylaxis action plan. Where possible paramedics should consider the action plan and align care in accordance to specialists recommendations.

Question 17

Transport notes

Answer 17

• All Pts with suspected or potential anaphylaxis must be advised that they should be transported to hospital regardless of severity or response to management.
• Hospital based obs is based for a minimum of4 hours in case of a bi phasic reaction, where symptoms return after initial resolution, this occurs in 20% of cases.

Question 18

Other causes of ANGIOEDEMA not caused by anaphylaxis

Answer 18

Several types of NON - ALLERGIC angioedema exist
- ACE - inhibitor induced angioedema
- Hereditary Angioedema (HEA)
- Bradykinn-mediated angioedema (broader category)

Question 19

NOTES about Angioedema causes not anaphylaxis

Answer 19

• These may present similar to anaphylaxis including abdominal signs and laryngeal swelling
• Won’t respond to adrenalin
• Urticaria and itching are typically absent
• Onset of symptoms slower than anaphylaxis
• Where HEA or bradykinn-mediated is identified and patient has a management plan, follow their plan and use their medications
• Otherwise strongly consider standard anaphylaxis management if indicated