Anaphylaxis (Paed) Flashcards
What age does the paediatric anaphylaxis guideline refer to?
< 12 years old
What is anaphylaxis?
- A severe, potentially life threatening systemic hypersensitivity reaction
- has a rapid onset usually within 30 minutes but may be up to 4 hours
what are the respiratory symptoms of anaphylaxis? and why are they caused?
- respiratory distress
- shortness of breath
- wheeze
- cough
- stridor
- they are caused due to inflammatory bronchoconstriction or upper airway oedema
what are some abdominal symptoms and why are they caused?
- abdo pain/cramping
- nausea, vomiting and diarrhoea
- can be caused by insect bites and systemically administered allergens e.g. IV meds
What are some integumentary symptoms and why are they caused?
- hives, welts, itching, flushing, angioedema (e.g. lips and tongue)
- caused due to vasodilation and vascular hyper permeability
What are some cardiovascular symptoms and why are they caused?
- Hypotension
- caused due to vasodilation and vascular hyper permeability
what are some common allergens for anaphylaxis?
- insect stings: bees, wasps, jumping jack ants
- food: peanuts/treenuts, egg, fish/shellfish, dairy products, soy, sesame seeds, wheat
- Medications: antibiotics, anaesthetic drugs, contrast media
- Exercise induced: typically affecting young adults (rare)
- Idiopathic anaphylaxis: No external trigger (rare)
why do anaphylaxis and asthma occur together?
- asthma, food allergy and high risk of asthma frequently occur together, often in adolescence
- bronchospasm is a common presenting symptom in this group, raising the likelihood of mistaking anaphylaxis for asthma
- a history of asthma increases the risk of fatal anaphylaxis
- you must maintain a high suspicion for anaphylaxis in patients with a history of asthma or food allergy
what are other causes of angioedema?
- hereditary angioedema (HAE) and its more broad categorisation: bradykinin-mediated angioedema
- these may present with similar symptoms to anaphylaxis including abdominal signs and symptoms and laryngeal swelling however will not respond to anaphylaxis management
What do you do if that patient has HAE or bradykinin-mediated angioedema?
Follow the patients treatment plan and use their medication
What is Food Protein Induced Enterocolitis (FPIES)?
- a non-immunoglobulin E mediated paediatric allergy that usually presents with nausea and vomiting, and in severe cases may present with collapse, confusion or altered consciousness.
Should FPIES patients be treated with adrenalin?
No
- if the patient has a positive diagnosis of FPIES and a care plan, treat symptomatically (e.g. ondansetron, IV fluid) and transport to hospital
- consider consultation with receiving hospital for steroid administration
what are the risk factors for refractory anaphylaxis or deterioration?
- expected clinical course (e.g. hx of refractory anaphylaxis/ICU admission/multiple adrenaline doses)
- Hypotensive
- Medication as precipitating cause
- Respiratory symptoms/distress
- history of asthma of multiple co-morbidities/medications
- No response to initial dose of IM adrenlaine
Where is the preferred administration site for adrenaline?
- anterolateral mid-thigh
do you Bring the patients adrenaline auto-injector with you to hospital?
yes
what do you do if you are waiting for MICA or waiting whilst the adrenaline infusion is being prepared?
Continue with IM adrenaline until arrival of MICA or whilst the infusion is being prepared
what is adrenaline toxicity? and what should you do if it is identified?
- it can be characterised by nausea, vomiting, shaking, tachycardia or arrhythmia but has some improvement in symptoms and a normal or elevated BP
- consider whether further noses are appropriate
What is the correct dose for children <10kg = 1 year old.
A minimum IM dose of 100mcg (0.1ml) is recommended to avoid order-of-magnitude errors if using the 1:1000 ampoule
when can you administer additional therapies for anaphylaxis?
- can be administered concurrently or in order of clinical need but must not delay continues adrenaline administration
what are some additional therapies for bronchospasm?
- where bronchospasm persists despite the administration of adrenaline, administer salbutamol, ipratropium bromide and dexamethasone.
- these medications should never be the first line of treatment for bronchospasm associated with anaphylaxis
what are some additional therapies for hypotension?
- where hypotension persists despite initial Adrenaline therapy, large volumes of fluid may be extravasating.
- IV fluid therapy is indicated to support vasopressor administration
What do you do if the anaphylactic patient has a management plan?
Where possible, paramedics should consider the action plan and align the care in accordance to the specialist recommendation
How long does an anaphylactic patient have to be monitored in hospital and why?
- minimum 4 hours
- in case of biphasic reaction, where symptoms return after an initial resolution
- this occurs in approximately 20% of cases
how do you set up an adrenaline infusion?
- via a syringe pump
- dilute adrenaline 300mcg to 50ml with 5% dextrose or normal saline (in a 50ml syringe)
- 1ml = 6mcg
- 1ml/hr = 0.1mcg/min
