Anaphylaxis

Question 1

What is anaphylaxis

Answer 1

• life threatening hypersensitivity
• severity, rapid onset and decline distinguish it from allergic reaction
• massive over release of histamine causes life threatening problems affecting the airway, breathing and circulatory systems

Question 2

Identification

Answer 2

• sudden onset of/ rapid progression of symptoms
• life threatening airway / breathing / circulation problems
• changes to skin colour / mucosa present

Question 3

Life threatening signs in anaphylaxis

Answer 3

Airway: strider
Breathing: hypoxia
Circulation: hypotension

Question 4

ABCDE anaphylaxis

Answer 4

Airway: soft tissues may swell // strider present

Breathing: Bronchoconstriction results in breathing difficulty and wheezing, which in early stages may be mistaken for asthma

Circulation: should be present to maintain both central and peripheral perfusion. Vasodilation results in hypotension and shock. Increase in heart rate follows in attempt to maintain central perfusion. Hypotension is compounded further by increased cell permeability, leading to loss of circulating volume.
Hypotension = life threatening circulatory sign

Question 5

Anaphylaxis presentation

Answer 5

Uni phasic
- symptoms occur suddenly, progress rapidly, but if successfully treated, do not reoccur without re exposure to the allergen

Biphasic
- mild/severe symptoms which appear to get better after treatment but reoccur without further exposure to the allergen

Protracted
- symptoms may fluctuate for days

Question 6

ABCDE assessment

Answer 6

A: strider / wheeze / hoarse voice / swelling
B: high respiratory rate / low oxygen saturations
C: high heart rate / low blood capillaries / prolonged capillary refill times
D: reduced consciousness / fatigue / confusion
E: rash / cyanosis / angiodema / sweating / cold peripheries

Question 7

Management of anaphylaxis

Answer 7

• call ambulance as soon as identifies
• request adrenaline to be drawn up and deliver asap
• administer 15L per min oxygen via a non rebreather mask
• administer salbutamol as a supportive measure - acts as a bronchodilator (supporting airway and breathing)

Question 8

Adrenaline dosage
Under 6 months

Answer 8

100-150mcg

Question 9

Adrenaline dosage
Under 6 years

Answer 9

150mcg

Question 10

Adrenaline dosage
6-12yrs

Answer 10

300mcg

Question 11

Adrenaline dosage
12 yrs +

Answer 11

500mcg