Anaphylaxis CPG

Question 1

what is the definition of anaphylaxis?

Answer 1

severe, potentially life threatening systemic hypersensitivity reaction

Question 2

what is the typical onset of anaphylaxis?

Answer 2

usually 30 minutes but may be up to 4 hours

Question 3

when is anaphylaxis accepted?

Answer 3

if there are two systemic manifestations observed irrespective of if there is a know allergen

Question 4

why des respect distress occur in anaphylaxis?

Answer 4

due to inflammatory bronchconstirction or upper airway oedema

Question 5

what abdominal signs may be observed with anaphylaxis?

Answer 5

pain/cramping, nausea, vomiting, diarrhoea- particularly with insect bites and systemically administered allergens ie IV medications

Question 6

what skin symptoms may be seen with anaphylaxis?

Answer 6

hives, welts, itching, flushing, angioedema (lips and tongue)- due to vasdilation and vascular hyperpermiability

Question 7

what cardiovascular symptoms may be observed with anaphylaxis?

Answer 7

hypotension due to vascular hyperpermiability

Question 8

what are some common allergens that may cause anaphylaxis?

Answer 8

insect sings - bees wasps, ants,
food- peanuts, egg, m fish 
medications
exerrcise induce
idiopathic anaphylaxis- no trigger

Question 9

when should the paitents own medication be used instead of anaphylaxis managment?

Answer 9

where HAE or bradykinin-medicated angiodema is identified and the patient has their own medication plan

Question 10

when should escalation of care be considered?

Answer 10

elected clinical course- ICU admission, multiple adrenaline administration
hypotension <90
medication as Ppercipertating cause
resp symptoms
history of asthma or multiple other co-morbidities/medications
or no response to initial dose of IM adrenaline

Question 11

what is the administration site for adrenaline in the setting of anaphylaxis?

Answer 11

anterolateral mid-thigh

Question 12

when might it be suggeestive that the patient is suffering from adrenaline toxicity rather than worsening anaphylaxis?

Answer 12

when the patient develops nausea, vomiting, shaking, tachycardia or arythmias but has some improvement in symptoms and a raised BP

Question 13

when can additional therapies be administered?

Answer 13

concurrently in order of clinical relevance however should not delay the administration of adrenaline

Question 14

what does inotropic mean?

Answer 14

medication that changes the force/speed of muscle contraction

Question 15

what does a chronotropic drug do?

Answer 15

effects electrical conduction pathways in the heart alerting

Question 16

what patients do we consider giving IM glucagon to and why?

Answer 16

paitents with a history of heart failure or paitents taking beta blockers

because it has an introit, chronotropic and antibronchospastic effect

Question 17

what should we do with mangamgnet plans?

Answer 17

consider action plan and align care in accordance to recommendations

Question 18

how long do paitents need to be observed in the hospital for after a reaction?

Answer 18

for a minim of 4 hours in case of a biphasic reaction

Question 19

what is the anaphylaxis criteria to treat as anaphylaxis?

Answer 19

sudden onset under 30 mins up to 4 hours

rash two or more
respirtory distress
abdominal symptoms
skin/muscosal symptoms
hypotension

or isloated hypotension <90 with know allaergen
or isolated resp distress following know allaergen

Question 20

what is the first line treatment for anaphylaxis?

Answer 20

500mgc Im adrenalin repate at 5 mins as required

request mica if first does not responsive
insert IV and O2 15L non rebreather

Question 21

what is the aditinal treatment is there is airway odeam/stridor?

Answer 21

adrenalin 5mg nebulised

• consult for further dose if required
• notify hopsital

Question 22

what is the aditinal treatment if there is bronchospasm?

Answer 22

Nebulised 5mg salbutamol or 4-12 pMDI repate at 20 mins if required

Ipatropium bromide 500mcg nebulised or pMDI 8 doses

Dexamethasone 8mg IV/Oral

Question 23

what are the additanl treatments if there is Hypotension?

Answer 23

<90 despite intial dose adrenaline

normal saline 40ml/kg tritrated to respnse- consult for further if required
consult not avaliable additional 20ml/kg

Question 24

what are the additaonal treatements for inadeqaute response to adrenaline with ahistory of heart ailure or taking beta-blockers

Answer 24

Glucagon 1mg Im repate once @ 5mins if required