Anaphylaxis Flashcards

1
Q

Define anaphylaxis.

A

Multisystem allergic reaction characterised by:
(1) Acute onset illness with typical skin features
PLUS
(2) Involvement of respiratory and/or cardiovascular symptoms and/or persistent GI symptoms

OR

Any acute onset hypotension or upper airway obstruction where anaphylaxis is considered possible even without skin features.

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2
Q

What is the immediate management of anaphylaxis?

A

10 mcg/kg or 0.01 ml/kg of 1:1000 (max 0.5 ml) into lateral thigh. Repeat after 5 mins if no improvement.

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3
Q

What are possible risk factors for fatal anaphylaxis?

A

Adolescence, nut/shellfish allergy, poorly controlled asthma, delays to emergency services/adrenaline, pre-existing cardiac/respiratory conditions

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4
Q

What sort of time frame do most anaphylactic reactions occur in?

A

30 mins. Can occur up to 4 hours post-exposure.

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5
Q

List features of anaphylaxis.

A

Respiratory: cough, wheeze, tongue swelling, stridor, hoarse voice, throat tightness, dysphagia.
CVS: pale/floppy, palpitations, tachy, brady, hypotension, collapse +/- LOC, arrest.
Neuro: headache, dizziness, ALOC/confusion.
GI: nausea/vomiting, diarrhoea, abdo pain
Derm: urticaria, erythema, flushing or angio-oedema

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6
Q

What are the autoinjectors available for anaphylaxis in children?

A

10-20 kg (~1-5 years old) = 0.15 mg = green label

> 20 kg (>5 years) = 0.3 mg = yellow label

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7
Q

How do you manage an adrenaline infusion in children?

A

Mix 1 ml of 1:1000 adrenaline in 1000 ml of normal saline. Start the infusion at 5 ml/kg/hr (~0.1 mcg/kg/min)

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8
Q

List the other treatments that can be considered with paediatric anaphylaxis in addition to adrenaline.

A

Salbutamol: especially if has a hx of asthma, is wheezing
Antihistamines: symptomatic relief of pruritus

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9
Q

What antihistamine should be avoided in anaphylaxis?

A

Promethazine; it causes hypotension.

Trial of a second generation.

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10
Q

What children should be admitted and for how long after anaphylaxis?

A

Minimum of 12 hours if: (a) need further treatment within 4 hours of last adrenaline administration, (b) previous hx of biphasic reaction, (c) poorly controlled asthma, (d) socially/geographically isolated family

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11
Q

What is the dose of adrenaline in a cardiac arrest situation?

A

10 mcg/kg = 0.1 ml/kg of 1:10,000 solution

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