Anaphylaxis Flashcards
What is the treatment of choice for anaphylaxis of all severities?
Epinephrine
When should epinephrine be given in anaphylaxis?
Even to mild cases! It is important to give early to prevent progression.
What is the dosing for the auto injector of epinephrine and frequency?
< 10kg should get weight based if possible, but if deteriorating then just give the 0.1mg dose or the 0.15 auto-injector will do
Kids < 25 kg get the 0.15mg dose
> 25kg get 0.3mg dose
>50kg give 0.5mg if possible, or just the 0.3mg dose if faster
Give in the thigh every 5–15 minutes or more frequently if needed!
What is the weight-based dosing for epinephrine?
0.01mg/kg with max of 0.5mg per dose
This is for any age
When is Epi given IM vs IV?
IM is preferred when not in shock, or severe distress
Progress to Epi drip if not responding to IM administration
What are the danger signs in anaphylaxis?
Rapid progression Respiratory symptoms: wheezing, difficulty breathing increased WOB, stridor, persistent cough, cyanosis Vomiting Abdominal Pain Hypotension Cardiac dysrhythmia Chest pain Collapse
What is the next step if patient is not responding to first dose of IM epi?
Give more epi! Titrate up to desired effect! Give it IV if you have to!!! Epi, Epi, Epi!!!
What is the starting dose for Epi drip?
0.1mcg/kg/min titrated to blood pressure, heart rate, oxygenation
When could glucagon be given in anaphylaxis?
To patients hypotensive, on beta blockers, and not responding to epi
What is the dose of glucagon and what is the side effect?
1–5mg for initial dose over 5 minutes with a drip added if needed
Causes vomiting if given too fast
Weight of patient is not known, what is usual dose range for starting epi drip?
2–10 mcg/min
Pt presents in anaphylaxis, what are the first steps?
Manage airway early as this is likely to deteriorate Simultaneously give epinephrine! Start fluids Use albuterol for breathing difficulty Place in recumbent position with feet up Give oxygen Manage BP
What are the adjunctive therapies?
Glucocorticoid
H1 and H2 blockers
Why is IM epi preferred over IV?
Usually faster administration and less cardiac complications and less hypertension and arrhythmias making it safer overall
When giving epinephrine, what should be done in obese patients?
Use a longer needle and do your best to access the muscle in the thigh through the overlying adipose tissue. Put it deep.
How is IV bolus of epi dosed and given and to whom?
IV bolus should be avoided for everyone when possible as errors in dosing lead to more severe adverse effects.
Give 50–100mcg slowly over 1–3 minutes and repeated only after 3 or more minutes of monitoring
Give only to adults, and avoid in kids.
Which of the drugs used in anaphylaxis are life saving?
Only epinephrine. None of the other drugs should be used alone.
Reduced mortality is associated with early administration of what drug?
Epinephrine!
What is the role of H1 blockers?
Only the control of itching and hives
It has no role in reversing or preventing airway obstruction or treating hypotension
It should not be given until after Epinephrine
What are the options and benefits of each H1 blocker?
Cetirizine: less sedating, comes in oral and IV, duration approaches 24 hours
Benadryl: commonly used but sedating, repeat every 4–6 hours
What is the dosing for Cetirizine?
> 12 years: 10mg IV/PO
6–11 years: 5–10mg
6mo–5y: 2.5mg
What is the dosing for benadryl?
> 50kg: 25–50mg Q4–6 hours, max 400mg in 24 hrs
<50kg: 1mg/kg up to 50, max of 5mg/kg or 200mg in 24 hours
What is the role of H2 blockers?
Might help with hives, but there is no data supporting its use
What is the difference is effect in the airways between epi and beta agonists?
Epi relieves the tissue edema and treats shock whereas bronchodilators only treat the bronchospasm
Bronchodilators are adjunctive therapies only and cannot replace epi and should only be given when epi is not effective
How long should anaphylaxis patients be monitored?
Until all symptoms have resolved
How do antihistamines and steroids affect biphasic anaphylactic reactions?
They do not have any effect on preventing a “rebound”
Epinephrine remains the mainstay of treatment
What is the role of steroids in anaphylaxis?
They do not need to be routinely given
Might consider in kids with refractory bronchospasm and underlying asthma and when they are staying in the hospital
Treatment for 1–2 days is good and a taper or prolonged course is not needed
What are the basic criteria to diagnose anaphylaxis?
Rapid onset Affects skin or mucosa Respiratory compromise BP decreases (or signs of decreased perfusion, including syncope) Abdominal complaints Exposure to potential or known allergen
