Allergy Emergency

Question 1

Anaphylaxis Treatment - in order of importance

Answer 1

1. Give Epinephrine
2. Positioning - place in Trundelenberg position
3. Give Oxygen
4. IV Fluids
5. Nebulized Albuterol
6. Vasopressors
7. Antihistamines
8. Steroids

Question 2

Anaphylaxis Mimics

Answer 2

1. Vasovagal reaction
2. Asthma
3. Angioedema
4. Acute MI/Unstable Angina
5. Pulmonary Embolus
6. Hypoglycemia
7. Seizure
8. Neuroendocrine Tumor (Pheochromocytoma, Carcinoid Tumor)

Question 3

Anaphylaxis vs. Vasovagal Reaction

Answer 3

ANAPHYLAXIS/VASOVAGAL

1. Rapid Pulse/Slow Pulse
2. Low BP/Normal BP
3. Skin: Red, Warm/Sweating, Pallor
4. Cough,Wheezing/ No cough or wheeze
5. Itching,Urticaria (95%)/No itching or urticaria
6. Feeling of Doom/No feeling of doom

Question 4

What are the clinical criteria for Diagnosing Anaphylaxis?

Answer 4

Anaphylaxis is highly likely when any one of the following 3 criteria are fulfilled:

1) Acute onset of an illness (minutes to several hours) with involvement of the skin, mucosal tissue, or both (e.g., generalized hives, pruritis or flushing, swollen lips/tongue/uvula) and at least one of the following:
- Respiratory compromise (e.g., dyspnea, wheeze/bronchospasm, stridor, reduced Peak Expiratory Flow, hypoxemia)
- Reduced BP or associated symptoms of end-organ dysfunction (e.g., hypotonia [collapse], syncope, incontinence)
2) Two or more of the following that occur rapidly after exposure to a likely allergen for that patient (minutes to several hours):
- Involvement of the skin-mucosal tissue (e.g., generalized hives, itch/flush; swollen lips/tongue/uvula)
- Respiratory compromise (e.g., dyspnea, wheeze/bronchospasm, stridor, reduced Peak Expiratory Flow, hypoxemia)
- Reduced BP or associated symptoms (e.g., hypotonia [collapse], syncope, incontinence)
- Persistent GI symptoms (e.g., crampy abdominal pain, vomiting)
3) Reduced BP after exposure to known allergen for that patient (minutes to several hours):
- Infants and children: low systolic BP (age specific) or greater than 30% decrease in systolic BP (Note: Low systolic BP for children is defined as less than 70mm Hg from 1 month to 1 year, less than (70mm Hg + [2 x age]) from 1-10 years, and less than 900 Hg from 11-17 years)
- Adults: systolic BP of less than 90 mm Hg or greater than 30% decrease from that person’s baseline

Question 5

Epinephrine Dose in Anaphylaxis

Answer 5

I. Intramuscular Epinephrine (1:1000):
1. Age > 12 years: 0.5mg IM
2. Ages 6 - 12 years: 0.3mg IM
3. Ages 1-5 years: 0.15mg IM

II. IV epinephrine (1:10,000):
1. 1mg IV Q3-5 minutes