Anaphylaxis

Question 1

Anaphylaxis

Anaphylaxis Pathology:

Answer 1

“Pre-existing IgE antibodies → mast cell degranulation → shock, airway compromise”

Question 2

Anaphylaxis

1:1000 epinephrine = ? mg/ml

Answer 2

1mg/mL

Question 3

Anaphylaxis

1:10000 Epi = ? mg/ml

Answer 3

0.1mg/mL

Question 4

Anaphylaxis

ASAP:

Answer 4

• ABCs
• 2 LB IVs w bolus
• O2, monitor
• Remove trigger
• T-berg if ↓ BP
• CXR
• TQT above local rxn site

Question 5

Anaphylaxis

Treatment Moderate Sx:

Answer 5

Epinephrine 0.3-0.5 mL IM (1:1,000), may repeat q 5 min prn
(Peds = 0.01 mL/kg IM q 5 min prn)

Question 6

Anaphylaxis

Treatment Severe sx:

Answer 6

• Epi drip: Mix 1 cc of 1:1000 epi (1000 mcg) in 1 L NS (makes 1 mcg/ml), drip 1-10 mcg/min, titrate (peds- 0.01 mg/kg/min 1:10,000)- 18g→ 20-30 mL/min

Question 7

Anaphylaxis

Epi Local infiltration:

Answer 7

0.1-0.2 mL 1:1000 SC Epinephrine at rxn site

Question 8

Anaphylaxis

EPI Nebulizer:

Answer 8

0.5ml of 2.25% Epinephrine sol in 2.5 ml NS (airway cart to bedside)

Question 9

Anaphylaxis

H1 blocker:

Answer 9

Diphenhydramine 50 mg PO/IV (max = 400 mg/d, titrate) Peds = 1 mg/kg PO/IV (max 300 mg/d)

Question 10

Anaphylaxis

Other nebs:

Answer 10

Albuterol 5 mg cont nebs Levalbuterol 0.625-1.25 mg nebs Ipratropium 0.5mg nebs (all in 3 mL NS, peds = 1/2 dose)

Question 11

Anaphylaxis

Steroids:

Answer 11

Solumedrol 125-250 mg IV (Peds = 40-80 mg IV) Dexamethasone 10 mg PO/IV (Peds = 0.6mg/kg up to 10 mg)

Question 12

Anaphylaxis

H2 Blockers:

Answer 12

Zantac (ranitidine) 50 mg IV or Tagamet (cimetidine) 300 mg IV/PO

Question 13

Anaphylaxis

Kitchen sink:

Answer 13

For refractory ↓BP: Glucagon 1-5 mg IV over 5 min, then 5-15 mcg/min drip (helpful in patients on B blockers- improves inotropy by increasing cAMP)