Anaphylaxis

Question 1

What is anaphylaxis?

Answer 1

Severe life-threatening generalised or systemic hypersensitivity reaction

Sudden onset
Rapid progression
Life-threatening airway, breathing, circulation problems
Skin/mucosal signs of urticaria or angioedema are usually present

Question 2

What causes anaphylaxis?

Answer 2

8% caused by food allergy: nuts, mil, fish, shellfish
Stings
Drugs - antibiotics, anaesthetics
Contrast media
Latex
Exercise
Inhalant allergens
Idiopathic

Most IgE mediated

RF:
Adolescent age group
Coexistant asthma
Nut allergy

Question 3

ABCDE assessment of anaphylaxis?

Answer 3

A:
Airway selling - pharyngeal/laryngeal oedema
Hoarse voice
Stridor

B: 
SOB
Wheeze
Tiredness
Confusion due to hypoxia
Cyanosis
Respiratory arrest

C:
Shock - pale clammy
Tachycardia
Hypotension -dizziness, collapse
Cardiac arrest

D: 
Reduced GCS
Confusion
Agitation
LOC

E:
Skin/mucosal changes
Urticaria 0- itchy wheals
Angioedema - eyelids lips

Question 4

DDX?

Answer 4

Septic shock
Life-threatening asthma
Faint (vasovagal episode)
Panic attack
Breath-holding anoxic episode
Idiopathic urticaria

Question 5

Management?

Answer 5

Call for help
Lie patient flat
Raise patients legs

Administer IM adrenaline 1:1000
Rpt after 5 mins if not better

Establish ariway
High flow oxygen
IV fluid challnage
Chlorphenamine (antihistamine)
Hydrocortisone

Monitor:
SaO2
ECG
BP

Question 6

What dose of adrenaline?

Answer 6

Adult: 500 micrograms IM (0.5ml)
Child > 12: 500 micrograms IM (0.5ml)
Child 6-12: 300 micrograms IM (0.3ml)
Child < 6: 150 micrograms IM (0.15ml)

Question 7

What fluid challenge?

Answer 7

Adult: 500-1000ml
Child: Crystalloid 20ml/kg

Question 8

What is chlorphenamine? What dose of chlorphenamine?

Answer 8

H1 antihistamine

IM
Adult or child >12    10mg
Child 6-12                 5mg
Child 6m-6y            2.5mg
Child < 6m               250 micrograms/kg

Question 9

What does of hydrocortisone?

Answer 9

IM
Adult or child >12    200mg
Child 6-12                 100mg
Child 6m-6y             50mg
Child < 6m               25mg

Question 10

How much adrenaline is 0.5mg IM

Answer 10

500 micrograms

0.5ml of 1:1000

Question 11

What doses of adrenaline 1:1000, chlorphenamine, hydrocortisone in:
<6m
6m-6y
6-12
12+

Answer 11

A C H

0. 15ml (150mcg) 25mcg/kg 25mg
1. 15ml (150mcg) 2.5mg 50mg
2. 3ml (300mcg) 5mg 100mg
3. 5ml (500mcg) 10mg 200mg