Anaphylaxis

Question 1

What are the signs and symptoms of anaphylaxis?

Answer 1

• Airway: swelling, hoarseness, stridor
• Breathing: high RR, wheeze, cyanosis, SpO2 <92%
• Circulation: pale, clammy, low BP, drowsy, coma
• Skin: urticaria (itching) /angioedema (swelling around lips and eyes)

Question 2

What is the management for anaphylaxis?

Answer 2

Initial assessment of acutely unwell child is with an ABCDE approach, assessing and treating:
Airway: Secure the airway
Breathing: Provide oxygen if required. Salbutamol can help with wheezing.
Circulation: Provide an IV bolus of fluids
Disability: Lie the patient flat to improve cerebral perfusion
Exposure: Look for flushing, urticaria and angio-oedema

• Intramuscular adrenaline (1:1000), repeated after 5 minutes if required
  > adults or children over 12 years is 500 micrograms
  > children between 6-12 years -> 300 micrograms
• Resuscitation with oxygen and fluids
  > IM/IV chlorphenamine - anti-histamine -> [10mg over 12years, 5mg 6-12 years (D), 2.5mg <6 years]
  > IM/IV hydrocortisone -> [200mg over 12years, 100mg 6-12 years, 50mg <6 years]
• Antihistamines, such as oral chlorphenamine 10mg (IM/ slow IV)or cetirizine
• Steroids - usually intravenoushydrocortisone 200mg IM/slow IV