Anaphylaxis

Question 1

What is the first step in managing a patient with suspected anaphylaxis?

Answer 1

ABCDE

Question 2

What has the UK Resus council said that the likely criteria for a diagnosis of anaphylaxis are?

Answer 2

Sudden onset and rapid progression of symptoms
Life-threatening airway and/or breathing and/or circulation problems
Skin and/or mucosal changes

(exposure to a known allergen also helps support diagnosis)

Question 3

What should be included in a general first inspection before ABCDE?

Answer 3

Check conscious level
Do they look well?
How is their breathing?
Obvious skin/mucosal changes?
Any drips?

Question 4

What airway signs may be found in anaphylaxis?

Answer 4

Airway swelling (difficulty talking/swallowing/breathing)
Stridor
Angioedema

Question 5

If any airway signs are found what should be done immediately?

Answer 5

Crash call for urgent anaesthetic input

Question 6

Whilst waiting on any help for airway management, what measures can be done yourself?

Answer 6

Head tilt, chin lift
Jaw thrust
Airway adjunct
- oropharyngeal airway
- nasopharyngeal airway

Question 7

What breathing signs may be present?

Answer 7

Reduced air entry
Wheeze
Cyanosis

Question 8

What investigations should be considered as part of the assessment of breathing?

Answer 8

ABG - important but do not delay anaphylaxis management

CXR - same as above

Question 9

What interventions should be considered in assessment of breathing?

Answer 9

Give high-flow O2 15L through a non-rebreather mask
Give nebulised bronchodilators
-salbutamol (~5mg)
-ipratropium bromide (500micrograms)

Question 10

What happens to the heart rate commonly in anaphylaxis?

Answer 10

Tachy - due to hypovolaemic shock

Bradycardia is a late sign, often preceeding cardiac arrest

Question 11

What happens to blood pressure in anaphylaxis?

Answer 11

Hypotension - fluid compartments shifts

Question 12

What bloods should be taken for somebody with suspected anaphylaxis?

Answer 12

FBC
U&Es
LFT
Clotting
CRP
Mast cell tryptase

Question 13

When should adrenaline be given in anaphylaxis?

Answer 13

At the C of ABCDE unless obvious trigger and patient has epipen.

Question 14

When should you ask for adrenaline to be prepared?

Answer 14

As you go to assess the patient if diagnosis is likely

Question 15

How much adrenaline is given in anaphylaxis?

Answer 15

0.5ml of 1:1000 adrenaline (500micrograms)

Question 16

When should repeat adrenaline be given after the first dose?

Answer 16

Every 5 mins if the patient remains in hypodynamic shock (max 5ml)

Question 17

Where is the ideal site for IM adrenaline?

Answer 17

Anterolateral aspect of the middle third of the thigh

Question 18

If you have given 2 doses of adrenaline without response, what is the next step?

Answer 18

Adrenaline infusion - consult with consultant/critical care team

Question 19

What should be given IV in the case of anaphylaxis?

Answer 19

Fluids (STAT) bolus of 500ml-1000ml
Chloramphenemine - 10mg IV
Hydrocortisone 200mg IV

Question 20

What can cause dip in conscious level in anaphylaxis?

Answer 20

Decreased cerebral perfusion due to hypotension or severe hypoxia

Question 21

What is often found on exposure of the patient with anaphylaxis?

Answer 21

Erythema
Urticaria
Angioedema