Anaphylaxis

Question 1

What are some signs of anaphylaxis?

Answer 1

Uritcarial rash / skin reaction
Angioedema of the eyes or lips 
Conjunctival injection
Laryngoedema causing stridor, breathing difficulties 
Bronchospasm causing cough 
Tachycardia 
Hypotension 
Shock

Question 2

What are some common precipitants for anaphylaxis?

Answer 2

The most common allergens include:

• Peanuts or other nuts
• Seafood
• Insect bites (especially wasps and bee stings)
• Drugs and IV injections e.g. antibiotics, NSAIDs, iron, heparin)

Question 3

How do we manage a case of anaphylaxis?

Answer 3

A-E approach
MANAGE AIRWAY - consider intubation / ventilation if necessary or emergency cricothyrotomy with 14G needle. 100% O2
LIE THE PATIENT DOWN if hypotensive (preserve blood flow to brain)
ADRENALINE - vasoconstrictor, decreased vascular permeability and improves contractility - overcome shock
START FLUIDS (500mL NaCl)
IV HYDROCORTISON 200mg
CHLORPHENAMINE 10mg - anti-histamine that will help regulate the inflammatory response

Question 4

What dose of adrenaline should be given. How and when?

Answer 4

Always give IM unless experienced with IV
1 in 1000 adrenaline 500mcg to adult or child above 12

A repeat dose can be given in 5 minutes if there is no response