ANAPHYLAXIS

Question 1

What is the standard prehospital dose of adrenaline in the three main age groups?

Answer 1

• 0 to 6 yrs: 150 µg
• 6 to 12 yrs: 300 µg
• >12 yrs: 500 µg

Question 2

What is the hospital dose of adrenaline in anaphylaxis?

Answer 2

10 µg/kg (0.01 mL/kg of 1:1000 strength)

repeat every 15 minutes

Question 3

What can you give via nebuliser if no response to IM adrenaline?

Answer 3

Nebulised adrenaline 1:1000 (1 mg/mL) → 400 micrograms per kilogram; max 5 mg

Question 4

How do you treat shock in anaphylaxis?

Answer 4

• Place in Trendelenburg position
• IV normal saline 20 mL/kg bolus

Question 5

What do you do if there is no response to 2 IM adrenaline injections?

Answer 5

IV infusion 0.1 mL/kg (1:10,000) over 2-5 mins

Question 6

What doses of hydrocortisone should be given?

Answer 6

Question 7

How long is the minimum time a patient should be monitored after anaphylaxis? Explain why. What should be monitored as a minimum?

Answer 7

Six hours to detect potential biphasic reactions

Monitor oxygen saturations, blood pressure, ECG as a minimum

Question 8

What blood levels can you take if diagnosis of anaphylaxis is uncertain?

Answer 8

Serum tryptase (peak 1-2 hrs after start of symptoms)