Anaphylaxis Flashcards

1
Q

What signs may indicate a patient is developing an anaphylactic reaction while under anaesthesia?

A
  1. Mucocutaneous - Erythema, Urticaria, Angioedema
  2. Respiratory - Bronchospasm, cough, hypoxia, inc airway pressure
  3. CVS - Hypotension, tachycardia, arrythmia, CVS collapse, arrest
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2
Q

What is the usual timeframe for development of anaphylaxis?

A

Usually immediate, but can be delayed by 30-60mins

latex allergy is often delayed

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3
Q

Outline the immediate management of anaphylaxis

A
  1. Call for help
  2. Delegate someone to get - crash trolley and anaphylaxis kit
  3. Cease all suspected triggers
  4. Check ECG - commence CPR if losing cardiac output
  5. Intubate, reduce volatile, give 100% O2
  6. Infuse fluids, elevate legs and insert IAL
  7. Give adrenaline - 1mcg/kg bolus 1-2mins PRN
  8. If signs persist - start adrenaline infusion -> pt requires a CVL
  9. Consider adjuncts ONLY when haemodynamics are stable
  10. Collect blood for tryptase levels
  11. Contact ICU
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4
Q

What are the IV and IM adrenaline bolus doses for anaphylaxis?

A
  1. IV 0.25-1mcg/kg
  2. IM Adult 500mcg
    1. 6-12 300mcg
    2. <6 150mcg
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5
Q

How is an IV adrenaline infusion set up?

A

3mg of Adrenaline in 50mLs of 5% dextrose or 0.9% NaCl - mLs/hr = mcg/min

Commence at 7mLs/hr

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6
Q

How would you manage severe bronchospasm?

A
  1. In circuit bronchodilators - Salbutamol, Ipratropium
  2. Salbutamol IV bolus (15mcg/kg upto 250mcg)
  3. Magnesium 50mg/kg over 20mins - max dose 2gm
  4. Hydrocortisone 1-2mg/kg IV
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7
Q

What other drug options are available for patients poorly responsive to Adrenaline?

A
  1. Noradrenaline infusion 0.1mcg/kg/min
  2. Metaraminol infusion 10mg/50mL saline - start at 5mL/hr
  3. Vasopressin 2U/hr
  4. Glucagon 1-5mg over 5mins (b-blocker reversal)
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8
Q

What further adjuncts can be considered once the patient is stable?

A
  1. Steroids to prevent late response - Hydrocortisone 2-4mg/kg or Dexamethasone 0.2-0.4mg/kg
  2. 2nd Generation anti-histamine (Loratadine)
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9
Q

What is the ANZCA DRSABCD of anaphylaxis?

A
  1. Danger and diagnosis - hypotensive with bronchospasm - cease all triggers
  2. Send for help
  3. Airway - establish an airway if airway oedema or compromise
  4. Breathing - FiO2 1.0
  5. Circulation - CPR if no pulse, give 1mg Adrenaline and follow CPR protocol, IV fluid bolus 20mLs/kg and rpt as required
  6. Drugs - Adrenaline - bolus, rpt, infusion
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