Anaphylaxis Flashcards
What is the mechanism behind anaphylaxis?
IgE stimulates rapid release of histamine and other pro-inflammatory chemicals from mast cells in mast cell degranulation, causing AW, breathing and/or cirulation compromise
Why do children have to be monitored carefully after an anaphylactic attack?
Biphasic reactions danger - 2nd reaction after successful treatment of first
How is anaphylaxis confirmed after management?
Serum mast cell tryptase within 6 hours of events
What to check when initially see someone with anaphylaxis?
Responsiveness/breathing - do they require CPR
If someone with anaphylaxis does not require CPR what check next
Chest - signs of lower and upper AW obstruction
Check pulse and BP for signs of circulatory collapse
Check skin inseide moth for urticaria and angio-oedema
Why must someone with anaphylaxis lie down and not stand up or sit up quickly>
Fatality can occur within minutes
Sit in semirecumbent position
Increase cerebral perfusion
When can you put someone with anaphylaxis in the recovery position?
When people are breathing normally but uncosncours
Why do pregnant women have to be put into the recovery position on their left?
Aortocaval compression
What is the dose for IM adrenaline for adults or children over 12 years old?
500 micrograms
What no longer recommended in emergency anaphylaxis
Antihistamines
Are steroids recommended in anaphylazis
NO - just fluid and adrenaline in emergency
If later -
Slow IM or IV 200mg
What is the emergency dose of adrenaline for children 6-12 years old?
1:1000, 300 micrograms - 0.3mL
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5mg
lord
100mg
Nebulised salbutamol dose in children over 6 years to adults
5mg
Salbutamol nebulised emergency dose 6 months to 6 years
2.5 mg
Adrenaline emergency dose for child 6 months to 6 years
150 micrgrams of 1:1000
Children undre 6 months emergency dose of adrenaline
100-150 micrograms of 1:1000
lol
2.5mg slow IM/IV
nope
25mg
nope
250 micrograms/kg
What is the best sized needle for adrenaline administration?
25mm needle at right angle to skin, strethced not bunched
What is the best sized needle for adrenaline administration?
25mm needle at right angle to skin, strethced not bunched
What should you recognise anaphylaxis from?
sudden onset and rapid progression of symptoms
Airway and/or Breathing and/or Circulation problems
skin and/or mucosal changes (flushing, urticaria, angioedema)
Where give IM adrenaline?
Anterolateral thigh
When do yuo repeat IM adrenaline in anaphylaxis?
5 minutes and ABC problems persist
When do you seek expert help in anaphylaxis?
Respiratory and/ore cardiovascular problems persist depite 2 doses of IM adrenaline -> iv ADRENALINE infusions
What skin/mucosal changes are ass with anaphylaxis?
flushing, urticaria, angioedema
When are IV fluids recommended for anaphylaxis?
Always
Esp in Refractor anaphyaxis, early in shock and hypotension
What treatment is third line and should not be used in ABC initial emergency management?
Antihistamines and steroids
What meds are no longer advised for routine emergency treatment of anaphylaxis?
Corticosteroids
IV fluid challenge amount in adults vs children?
Adult - 500-1000ml
Child - 10mL/kg
Signs of life threatening problems with AW
Hoarse voice, stridor
Breathing - signs of life threatening problems
Increased work of breathing, wheeze, fatigue, cyanosis, So02, <94%
Steps in emergency anaphylaxis
A-E assess
Call for help
Remove trigger. lie flat
IM adrenaline
Establish airflow, highlow oxygen
Monitoring - ECG, BP, pulse oximetry
Symptoms of anaphylaxis
- Urticaria
- Itching
- Angio-oedema, with swelling around lips and eyes
- Abdominal pain
- Shortness of breath
- Wheeze
- Swelling of the larynx, causing stridor
- Tachycardia
- Lightheadedness
- Collapse
-Changes in bowel habit
What is important to cover after anaphylaxis in a child?
Educate child and parent on trigger, how to avoid and spot signs
Parents - trained in BLS and how to use adrenaline autoinjector
What are trade names of adrenalin autoinjectors?
Epipen, Jext, Emerade
What risk factors are present for autoadrenaline epipens to be given out for allergic reactions that dont cause anaphylaxis?
Asthma requiring inhaled steroids
Poor access to medical treatment eg rural locations
Adolescenets (higher risk)
Nut or insect sting allergies
Significant co-morbidities eg cardiovascular disease
How to use an adrenalin autoinjector?
Prepare device - remove safety cap (blue or yellow, non needle end)
Grip the device in fist needle down
Administer injection - firmly jab by device into outer portion mid thigh until clicks
3s for EpiPen, 10s (Jext)
Remove device and massage area for 10 seconds
