Anaphylaxis

Question 1

Initial steps

Answer 1

Airways + restore BP
Raise legs and lie flat
Unconscious = recovery posittion

Question 2

Adrenaline

Answer 2

1 in 1000
IM injection to anterolateral aspect of mid-thigh
Repeat every 5 mins if necessary

Question 3

Dose

Answer 3

<6 = 150 mcg
6-12 = 300 mcg
12-18 = 500 mcg

Question 4

IV

Answer 4

Give IV if compromised circulation.

Question 5

Beta blockers

Answer 5

Beta-blockers may not respond to Adrenaline.
Consider bronchodilator e.g. IV Salbutamol

Question 6

Adjunct

Answer 6

High flow oxygen
IV fluids
Chlorphenamine injection
- counters histamine mediated vasodilation/bronchoconstriction
Hydrocortisone injection
- prevents further deterioration in severely affected patients

Question 7

Self-administration

Answer 7

Adrenaline auto-injectors
- Jext, EpiPen, Emerade

Question 8

Counselling

Answer 8

Carry two pens at all times
Administer to midpoint of outer thigh
Second injection 5-15 minutes after first injection.
Call ambulance even if better
Lie down + raise legs/sit up if difficulty breathing.

Question 9

MHRA advice

Answer 9

• Prescribe 2 injectors, carry at all times.
• Patient/carer trained on how to use.
• Check EXP dates and get replacements before expiry.

Question 10

Angiodema

Answer 10

• Swelling of skin
• Severe cases = laryngeal oedema, TREAT AS FOR ANAPHYLAXIS