Anaphylaxis Flashcards
Recognition of anaphylaxis
Likely when patient is ill after exposure to trigger.
Sudden onset of airway, breathing or circulation problems.
Skin or mucosal changes eg urticaria, angioedema, flushing.
ABC problems
Airway
Tongue or throat swelling
Hoarse voice
Stridor - high pitched insp noise
B
Wheeze, persistent cough
Hypoxaemia- less than 94%
Fatigue
Resp arrest
C
Signs of shock - pale, clammy, tachycardia, hypotension
Dizziness, loss of consciousness
Arrhythmia
Cardiac arrest
Assessment anaphylaxis
- ABCDE
A - hoarse voice, stridor
B - effort, wheeze, fatigue, cyanosis, SpO2<94%
C - low BP
D - dec consciousness
E - flushed, itchy, urticaria, angioedema
- Diagnose - sudden onset of ABC problems and skin changes
- Resus team or ambulance
Emergency Management
- Remove trigger
- Lie patient flat or sitting position
3. Use IM adrenaline 1mg/ml and give 500mg (if>12). Inject at anterolateral middle third of thigh. ( 6-12 yrs = 300mg, 6months to 6yrs = 150mg, <6months = 100-150mg )
- Establish airway, give O2.
Take obs eg pulse oximetry, ECG and BP - If no response repeat IM adrenaline after 5 mins. Give IV food bolus.
Long term management
Prescribe adrenaline auto-injector (unless drug induced)
Specialist referral to allergy clinic
Patient education
Reporting
Investigations
Do not delay treatment
● 12-lead ECG
●Chest x-ray
●urea and electrolytes
●blood gases
● mast cell tryptase - minimum one sample within 4h of onset of symptoms
Ideally take 3 - as soon as feasible, 1-2h, 24h after resolution.
Refractory Anaphylaxis (hospital)
Anaphylaxis requiring ongoing treatment (due to persisting respiratory or cardiovascular symptoms) despite 2 appropriate doses of IM adrenaline.
Give rapid IV fluid bolus (eg 0.9% NaCl) and start adrenaline infusion.
Treat ABC symptoms - Give high flow O2 to get 94-98%. Monitor HR, BP, oximetry and ECG for arrhythmia.
Take blood sample for mast cell tryptase.
