Anaphylactic Reaction

Question 1

Remember as soon as possible…

Answer 1

Cease/Remove causative agent.

Question 2

Clinical Severity Prompts (3)

Answer 2

1. Sudden onset rapid progression of symptoms
2. Life-threatening Airway and/or Breathing and/or Circulation problems are present
3. Skin and/or mucosal changes (flushing, urticaria, angioedema)

Question 3

Relevant Hx & Assessment prompts (8)

Answer 3

1. Onset
2. Exposure to known allergen for patient
3. Associated symptoms:

• resp. distress,
• peripheral vasodilation,
• hypotension,
• urticaria,
• generalised skin redness,
• periorbital oedema

4. Flushing, urticaria & angioedema can be absent in up to 20% of cases
5. GIT symptoms: vomiting, abdo pain, incontinence
6. Relevant PmHx
7. Medications
8. Allergies

Question 4

Airway - Assessment

Answer 4

Assess patency

Stridor?

Hoarse voice?

Question 5

Airway - Intervention

Answer 5

Maintain airway

If stridor present give IM ADRENALINE 0.5mg every 3-5min (to total of 2mg)

Question 6

Breathing - Assessment

Answer 6

Respiratory rate & effort

SpO2

Auscultation - Wheeze?

Question 7

Breathing - Intervention

Answer 7

Assist ventilation if required

Apply O2 to maintain SpO2 >95%

If wheeze present give SALBUTAMOL 10 puffs of 100mcg dose MDI + spacer

Question 8

Circulation - Assessment

Answer 8

Skin temperature (touch)

Pulse - rate/rhythm

Blood pressure

Capillary refill

Cardiac monitor

Question 9

Circulation - Intervention

Answer 9

IV cannulation

If pulse rate >100bpm, SBP <90mmHg & capillary refill >2secs → give IV 0.9% NaCl 1000ml bolus.

Monitor vital signs frequently

Question 10

Disability - Assessment

Answer 10

AVPU/GCS & pupils

Question 11

Disability - Intervention

Answer 11

Monitor LOC and/or altered consciousness