Anaphylaxis

Question 1

?

Answer 1

Systemic type I (IgE mediated) life-threatening hypersensitivity reaction

Immediately get help, call medical emergency team on 2222 and remove allergen

Question 2

Airway

Answer 2

Secure airway
Adrenaline 0.5mg IM (0.5 mL of 1:1000): may be repeated at 5 minute intervals

(the injections come as 1mL so dispose of 0.5 mL before injecting)

Question 3

Breathing

Answer 3

Attach 15L / minute oxygen via non-rebreather mask

If wheeze give salbutamol 5mg NEB

Question 4

Circulation

Answer 4

IV access via 2 large bore cannulas
IV fluids 500-1000mL 0.9% saline / Hartmann's STAT fluid challenge initially 
Hydrocortisone 200mg IV
Chlorpheniramine 10mg IV
Apply 3-lead cardiac monitoring

Question 5

Further short term management

Answer 5

If not improving rapidly seek anaesthetic / ICU input
Admit forobservations (at least 6 hours post adrenaline)
Continue pred 30-40mg OD PO (3-5 day course)
Continue chlorpheniramine 4mg QDS PO if itching
Monitor ECG
Further IV fluids required
Document event and allergy
Consider taking mast cell tryptase to confirm anaphylaxis (must be done ASAP)

Question 6

Longer-term management

Answer 6

Educate pt
Teach about self-injected adrenaline
Medic alert bracelet
Refer to allergy clinic and skin pricks to identify allergens if unknown
Clinical incident form if given allergic abx