Anaphylaxis

Question 1

How should emergency presentations be managed?

Answer 1

A-E assessment - ABC often affected in anaphylaxis

Question 2

Things to particularly look for in anaphylaxis

Answer 2

• Sudden airway+/- breathing +/- circulation problems
• • Skin changes (eg itchy rash)

Question 3

Management of anaphylaxis

Answer 3

• Lie pt flat or sitting
• If pregnant lie on left side
• Remove trigger
• Give IM adrenaline - 0.5mg 1 in 1000 (500 micrograms, 0.5mls) (anterolateral middle third thigh)
• Establish airway
• Give high flow O2
• Apply monitoring - pulse oximetry, ECG, BP
• If no response - rpt IM adrenaline after 5 mins
• Give IV fluid bolus (500ml-1000ml adutls)

Question 4

Life threatening aspects of ABC

Answer 4

A - stridor, hoarse voice
B - Increase work breathing, wheeze, fatigue, cyanosis, O2 sats less than 94%
C - low BP, signs of shock, confusion, reduced conc

Question 5

If no improvement in breathing and circulation despite 2 doses of IM adrenaline?

Answer 5

• Confirm resus team/ambulance ahs been called
• Follow refractory anaphylaxis algorithm

Question 6

Refractory anaphylaxis algorthithm

Answer 6

• Seek expert help early - critical care and establish peripheral IV or IO access
• Give rapid IV fluid bolus 0.9% saline
• Start adrenaline infusion - NOT same side as BP cuff, have dedicated line
• Give IM adrenaline every 5 minutes until infusion starts

Question 7

Common causes of anaphylaxis

Answer 7

• Drugs - penicillin, contrast media in radiology
• Latex
• Stings
• Food - egg, fish, peanuts, strawberries
• Semen

Question 8

Pathophysiology of anaphylaxis

Answer 8

• Type I IgE mediated hypersensitivity reaction
• IgE cross links on mast cell and causes release of histamine etc
• Capillary leak, vasodilation, wheeze, cyanosis, oedema (larynx, lids, tongue, lips)
• Urticaria

Question 9

Advice to give pt on discharge

Answer 9

• Ensure referral to specialist for allergy advice
• Adrenaline autoinjector given to take home x2 - ensure demonstrate how to use, carry at ALL times, check expiry
• Signs and symptoms - ABC and rash
• Bracelet alerting others to anaphylaxis?
• Leaflets
• Inform about Biphasic reaction - initial presentation, recover, then another reaction without re-exposure