Anaphylaxis Management

Question 1

What approach do you use when dealing with any medical emergencies?

Answer 1

The ABCDE Approach

Question 2

What does ABCDE stand for?

Answer 2

Airway, Breathing, Circulation, Disability/Diabetes, Exposure/Everything else

Question 3

What are you checking for when you’re assessing the airway?

Answer 3

Checking to see if the airway is patent or blocked.

Question 4

How is a partially blocked airway indicated?

Answer 4

By noises such as stridor, wheezing or gurgling.

Question 5

How is a fully blocked airway indicated?

Answer 5

No noise at all

Question 6

How do you assess breathing?

Answer 6

Check their:

1. Respiratory rate - should be sitting between 12-20. Anything above 25 is concerning.
2. Oxygen saturation - should be 96% or above. Anything lower is a problem.
3. Chest elevation - both sides or just one side and regular or irregular

Question 7

How do you assess circulation

Answer 7

Assess:

1. Pulse rate - should be 60-100 bpm (anything above 100 bpm is a problem)
2. Blood pressure - should be in the range of 120/70. Anything drastically out of this range is a problem.

Too high = hypertension
Too low = hypotension

3. Capillary refill time - should be 2 seconds or below. However, this is a subjective measure as the patient could naturally have poor circulation.

Question 8

How do you assess Disability/ Diabetes?

Answer 8

Disability:

Use the ACVPU Scale:

• Alert
• Conscious
• Verbal
• Pain
• Unconscious

Deteriorates as you go further down the scale

Diabetes:

• Measure blood glucose levels using a finger prick
• Anything lower than 4mmol indicates hypoglycaemia. Restore blood glucose levels by providing something sugary.
• Too high is hyperglycaemia. Usually hyperglycaemic is blood glucose levels are above 7 mmol before a meal and above 8.5 mmol 2 hours after a meal. Give patient insulin to restore their blood glucose levels.

Question 9

How do you assess Exposure/Everything else?

Answer 9

Expose the patient whilst remaining their dignity to check for:
- Skin or mucosal changes such as swelling, rashes, bruising or colour changes, bleeding

Check the patients temperature - too high could indicate sepsis!

Question 10

What is anaphylaxis?

Answer 10

A life threatening hypersensitivity reaction that can affect the airway, breathing, and circulation of the body

Question 11

How can anaphylaxis be triggered?

Answer 11

By allergies

Question 12

What allergens in a dental setting are likely to trigger anaphylaxis?

Answer 12

Latex, Chlorhexidine Mouthwash, and Penicillin

Question 13

What is the physiology behind anaphylaxis?

Answer 13

When exposed to the allergen mast cells release histamine which in turn sets the body into shock. This can cause the fluid and blood to move away from the heart causing swelling in eyes, throat (causing breathing problems) and causing a drop in blood pressure resulting in an increase in heart rate - this can result in cardiac arrest so much be managed correctly!

Question 14

Patient is suffering from an anaphylactic shock. How would you manage this?

Answer 14

1. Call for help
2. Call 999
3. Remove the trigger if known
4. Lie patient supine - legs elevated if possible
5. Run through ABCDE approach to diagnose the problem.
6. Once diagnosed as anaphylaxis. Check to see if the patient is carrying an epipen. If so use this to inject the anterolateral thigh.
7. If no epipen, administer 1:1000 (1mg/ml) Adrenaline using a capsule and needle into the anterolateral thigh - for children 12 and above administer 0.5mg/ 0.5 ml (half a capsule)
8. Also provide high flow oxygen through a non-rebreather mask. 15 litres/min.
9. If there are no changes after 5 mins of administering the adrenaline repeat again and keep doing so every 5 minutes until the ambulance turns up.

Question 15

The patient suffering from anaphylaxis has now become unconscious. What are you going to do?

Answer 15

Commence CPR - 30 chest compressions (stayin alive), 2 mouth to mouth

If defibrillator is available you could use this.