Anaphylactic Shock

Question 1

Mx of anaphylaxis:

Answer 1

1. Secure the airway - give 100% O2 -
   Intubate if obstruction imminent
2. Remove the cause
3. Raise the feet - may help restore the circulation
4. Give ADRENALINE IMI 0.5mg stat - 0.5mL of 1:1000 (Repeat every 5min)
5. Secure IV access
6. Chlorphenamine 10mg IV
7. Hydrocortisone 200mg IV
8. IVF - 0.9% N/S, eg 500mL over 15 min; up to 2L may be needed - Titrate against blood pressure
9. If wheeze - Rx for asthma - Salbutamol 5mg nebulized with O2
10. Still hypotensive - ICU - ± IVI of adrenaline ± aminophylline & nebulized salbutamol

Question 2

Further Mx of anaphylaxis:

Answer 2

1. Admit to ward
2. Monitor ECG
3. Measure mast cell tryptase 1–6h after suspected anaphylaxis
4. Continue chlorphenamine 4mg/6h PO if itching
5. ‘MedicAlert’ bracelet
6. Teach about self-injected adrenaline (eg 0.3mg, Epipen®) to prevent a fatal attack
7. Skin-prick tests showing specific IgE help identify allergens to avoid

Question 3

IV dose of adrenaline

Answer 3

1. The IV dose is different: 100μg/min - titrating with the response
2. This is 0.5mL of 1:10,000 solution per minute.