Anaphylaxis

Question 1

What are 4 common characteristics of anaphylaxis?

Answer 1

Hypotension, bronchospasm, angioedema, erythema (rash)

Question 2

What is the treatment for adults with anaphylaxis?

Answer 2

Basic care, consider clinical support, posturing, adrenaline (10 microgram/kg IM - max dose of 500 micrograms - repeated every 5 minutes), high flow oxygen/IPPV, 0.9% sodium chloride to achieve an adequate blood pressure, transport to further care with hospital notification, fexofenadine 180mg if appropriate.

Question 3

What is the treatment for paediatrics with anaphylaxis?

Answer 3

Consider clinical support early, basic care, posturing, adrenaline (10 microgram/kg IM - max dose of 500 micrograms - repeated every 5 minutes), high flow oxygen/IPPV, transport to further care with hospital notification.

Question 4

In anaphylaxis, what is the repeated 5 minute dosage of adrenaline for a paediatric/person weighing:
1. 14 kg
2. 16 kg
3. 43 kg
4. 46 kg
Additionally, if unsure of a paediatric dose, what should you always do?

Answer 4

1. 140 micrograms [150]
2. 160 micrograms [200]
3. 430 micrograms [450]
4. 460 micrograms [500]
   Check the paediatric drug card. In anaphylaxis, adrenaline doses are rounded to a convenient therapeutic dose [shown in brackets]

Question 5

When should fexofenadine be administered in the case of anaphylaxis, what is the dosage, and why do we administer it?

Answer 5

180mg in adults only, when oral administration is appropriate and will not cause airway compromise. The purpose of its administration is to inhibit the release of inflammatory mediator histamine.

Question 6

Why is it recommended that all patients with anaphylaxis be transported to hospital for further care, despite an improving patient presentation?

Answer 6

Anaphylaxis symptoms can be present and re-commence hours after the initial presentation. Additional therapy is often provided in hospital with close evaluation.

Question 7

Why is IC support beneficial in patients presenting with anaphylaxis?

Answer 7

ICP’s can administer an adrenaline infusion to treat hypotension, as well as IV hydrocortisone.

Question 8

What type of shock does anaphylaxis cause, and how?

Answer 8

Distributive shock. Mast cell degranulation releases inflammatory mediators, causing widespread vasodilation and increased capillary permeability. Blood volume is lost to the interstitial space, causing profound hypotension.

Question 9

Nausea and vomiting are common symptoms of anaphylaxis. When would we consider withholding ondansetron in the case of anaphylaxis?

Answer 9

If the patients has orally ingested the allergen. Vomiting will help to remove the allergen from the stomach.

Question 10

In patients with known anaphylactic allergies, what is an important historical question we can ask in regards to their self-care or allergy plan?

Answer 10

Do you have an EpiPen? If so, is it in date, have they administered it and when did they administered it?

Question 11

How much IV fluid do we give to an adult patient with anaphylaxis?

Answer 11

0.9% saline to achieve an adequate blood pressure.