anaphylaxis

Question 1

what are the symptoms of anaphylaxis?

Answer 1

sudden onset + rapid progression of symptoms

A- swelling of throat/tongue results in hoarse voice + stridor

B- dyspnoea + wheeze

C- hypotension + tachycardia

skin + mucosal changes can be:
- generalised pruritus
- widespread erythematous or urticarial rash

Question 2

what is the treatment of anaphylaxis age>12yo?

Answer 2

IM adrenaline 500micogram
0.5ml 1 in 1000

can be repeated every 5 mins
anterolateral aspect of middle third of thigh

Question 3

what is the treatment of anaphylaxis age<6mo?

Answer 3

IM adrenaline 100-150 micrograms

0.1-0.15ml 1 in 1000

Question 4

what is the treatment of anaphylaxis age 6m-6yrs?

Answer 4

IM adrenaline 150 micrograms

0.15ml 1 in 1000

Question 5

what is the treatment of anaphylaxis age 6-12yo?

Answer 5

IM adrenaline 300 micrograms

0.3ml 1 in 1000

Question 6

what is refractory anaphylaxis?

Answer 6

respiratory +/or cardiovascular problems persist despite 2 doses of IM adrenaline

IV fluids should be given for shock

senior help + consider IV adrenaline infusion

Question 7

what is the management of anaphylaxis following stabilisation?

Answer 7

1. non-sedating antihistamines esp if persisting skin symptoms (urticaria +/- angioedema)
2. serum tryptase - remain elevated up to 12hrs following acute episode
3. refer to specialist allergy clinic
4. adrenaline injector be given at interim measure before specialist allergy assessment unless reaction was drug-induced
5. prescribed 2 adrenaline auto-injectors
6. risk stratififed approach to discharge as biphasic reactions can occur in 20% of patients

Question 8

describe the categories of risk-stratified approach to discharge

Answer 8

1. fast track discharge after 2 hours of symptom resolution
2. minimum 6 hours after symptom resolution
3. minimum 12 hours after symptom resolution

Question 9

in what cases can people have a fast-track discharge after 2 hours of symptom resolution?

Answer 9

fast-track discharge after 2 hours of symptom resolution if
- good response to 1xdose adrenaline
- complete resolution of symptoms
- given adrenaline auto-injector + trained
- adequate supervision following discharge

Question 10

in what cases can people be discharged 6 hours after symptom resolution?

Answer 10

2 doses of IM adrenaline needed
or previous biphasic reaction

Question 11

in what cases can people be dishcarged after 12 hours of symptom resolution?

Answer 11

severe reaction requiring >2 doses of IM adrenaline

severe asthma

possibility of ongoing reaction eg if slow-release medication

presented late at night

in areas where access to emergency access care may be difficult