anaphylaxis management

Question 1

what is anapylaxis

Answer 1

systemic type 1 IgE mediated life threatening hypersensitivity reaction

Question 2

first point of call

Answer 2

get help, call cardiac arrest team
remove allergen
check HR and BP
do not allow patient to stand or walk
give high flow oxygen
A-E assessment
cotinuous cardiac monitoring and pulse ox

Question 3

what to administer

Answer 3

IM adrenaline
10mcg/kg
use adrenaline autoinjector if more readily available
if patient remains symptomatic, repeat every fine minutes as needed

Question 4

what to do for the shocked and hypotensive patient

Answer 4

inform seior doctor
insert large bore Iv cannula
rapid IV bolus of sodium chloride
20ml/kg 0.9% saline
repeat as necessary
adrenaline infusion if still hypotensive after 40ml/kg sodium chloride
admit

Question 5

if the symptoms resolve

Answer 5

observe for minimum 4 hours after last adrenaline done (admit to ED short stay unit or inpatient ward)
monitr for symptoms and signs of anaphylaxis
provide education and anaphylaxis action plan
discharge with adrenaline autoinjector

Question 6

additional measures

Answer 6

nebulised adrenalne for upper airway obstruction
inhaled sabutamol for persistant wheeze

Question 7

management

Answer 7

administer high flow oxygen
record full set of obvs in Observation and response tool
document chest auscultation and perfusion

Question 8

signs of shock

Answer 8

insert two large IV cannulae and give an 20ml/kg sodium chloride bolus
asess response and repeat as necessary
commence an adrenaline infusion if thee patient remains hypotensive
paediatric critical care referraal

Question 9

signs of upper airway obstruction

Answer 9

nebulised adrenaline
consider need for intubation and prepare equipment
consider adrenaline infusion
continuous cardiac monitoring, pulse oximetry

Question 10

signs of persistent wheeze

Answer 10

give salbutamol metered dose inhaler (MDI) via spacer
consider repeating IM adrenaline
consider adrenaline infusion

Question 11

where to admit the patient

Answer 11

all patients who have recieved Im adrenaline must be observed for a minimum of 4 hours after the last dose of adrenaline
have a low threshold to admit overnight if pateint presents in the late evening
admit to PCC if adrenaline infusion is required

Question 12

at discharge

Answer 12

prescribe (PBS authority) two adrenaline autoinjectors
epipen - 300mcg
Anapen - 500mcg (if above 50kg)

Question 13

how to inject epipen

Answer 13

form fist around epipen and pull off safety release
place orange end on outer mid thigh (with or without clothing)
push down hard until click is heard or felt
hold for three seconds
remove pen

Question 14

oropharyngeal airwaay

Answer 14

guedel
used to relieve soft palate obstruction
should only be used in unconscious patients otherwise it is poorly tolerated and may induce gagging and asppiration

Question 15

how to insert a guedel

Answer 15

open the patients mouth and insure ther is no foreign body
insert oropharyngeal airway directly
maintain head tilt chin lift or jaw thrust and assess the patency of the patients airway

Question 16

nasopharyngeala airway

Answer 16

check the patency of the patients right nostril
lubricate the NPA
insert the airway bevel end first vertically along the floor of the nose with a slight twisssting action

Question 17

role of antihistamine

Answer 17

can be used to treat skin ymptoms once the patient is stabilised