Adult Anaphylaxis Flashcards
Define Anaphylaxis
Severe, potentially life-threatening systemic hypersensitivity reaction
Care objectives for Anaphylaxis CPG
- Adrenaline IM with minimal delay
- Airway and perfusion support
- Hospital based observation (usually 4 hr) at a minimum
Anaphylaxis Criteria
Sudden onset of symptoms (usually <30 min but up to 4 hours
AND
2 or more of RASH +/- confirmed exposure to an Antigen
Additional Reminder for Anaphylaxis
- 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
IM Adrenaline Adult Doses in Anaphylaxis
500mcg IM
Repeat @5/60 intervals as required
When to request MICA in Anaphylaxis
If presenting with risk factors OR not responsive to initial Adrenaline.
Risk Factors for Anaphylaxis
- Hx of refractory or ICU.
- Hypotensive BP <90
- Medication as precipitating cause
- Respiratory symptoms / respiratory distress
- History of asthma or multiple co-morbidities/medications.
Initial Mx for Anaphylaxis
IM Adrenaline
Request MICA
Insert IV
O2 10-15L NRB
Additional Therapies in Anaphylaxis
Airway Oedema: Adrenaline Nebulised.
Bronchospasm: Salbutamol + Ipratropium Bromide + Dexamethasone.
Cardiovascular/Hypotension: Fluids
Beta Blocked/CCF: Glucagon
Airway Oedema/Stridor - Anaphylaxis
Adrenaline 5mg Nebulised
- Consult for repeat doses
- Notify receiving hospital
Bronchospasm in Anaphylaxis
- 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
Glucagon Mx in Anaphylaxis
If inadequate response to Adrenaline with history of heart failure OR taking Beta Blockers:
- Glucagon 1mg IV / IM
- Repeat dose @5/60
Additional therapy notes
- 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
Adrenaline Notes in Anaphylaxis
- IM Adrenaline is the primary treatment for anaphylaxis.
- IM Site: Anterolateral mid-thigh.
- Adrenaline Infusion: where ……….
Define inotropic, chronotropic
- Inotropic effects, increasing the strength of the muscle contractions (ventricles).
- Chronotropic effects, increasing the rate or timing of physiological effect such as HR
Management Plan notes
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.
Transport notes
- 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.
Other causes of ANGIOEDEMA not caused by anaphylaxis
Several types of NON - ALLERGIC angioedema exist
- ACE - inhibitor induced angioedema
- Hereditary Angioedema (HEA)
- Bradykinn-mediated angioedema (broader category)
NOTES about Angioedema causes not anaphylaxis
- 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
