anaphylaxis (resus council guidelines)

Question 1

in what situations should you give adrenaline?

Answer 1

any airway problem
 - hoarseness
 - tongue swelling
 - lip swelling
 - periorbital oedema
if unsure, give don't delay

Question 2

ABCDE what to look for

Answer 2

A - hoarse, stridor
B - increased work, wheeze, fatigue, cyanosis
C - low bp, confusion, signs of shock, reduced consciousness, can’t palpate radial pulse
usually skin changes e.g. itchy rash

Question 3

tx of anaphylaxis order

Answer 3

ABCDE
HELP
remove trigger
lie flat
IM adrenaline 500mcg
airway
high flow O2
monitoring
repeat IM 5mins
IV fluid bolus
if no improvement after 2 doses follow refractory anaphylaxis algorithm - tell help

Question 4

alternatives to lying flat

Answer 4

NOT stand up
can elevate legs
sitting may make breathing easier
pregnant - lie left side

Question 5

IM adrenaline

Answer 5

500mcg
0.5ml of 1:1000 (1mg/ml)
anterolateral aspect middle 1/3 thigh

Question 6

why shouldn’t you get pt to stand up?

Answer 6

get vasodilation - fluid leaks - preload down
so if you stand up you aren’t filling ventricles properly - cardiac arrest
lying down adrenaline more effective as more blood in heart

Question 7

technique of giving IM adrenaline

Answer 7

anterolateral aspect middle 1/3 of thigh
tension on muscle
once think in muscle retract - if blood advance 1-2mm and repeat
once done bring needle 1/2 way out, then lose tension on muscle then remove

Question 8

what should you do if no response to IM adrenaline?

Answer 8

repeat after 5mins (change site)

IV fluid bolus

Question 9

what should you do if no improvement in b/c problems despite 2 doses?

Answer 9

confirm help has been called, tell help

follow refractory anaphylaxis algorithm

Question 10

refractory anaphylaxis

Answer 10

no improvement in respiratory or CV symptoms despite 2 doses of IM adrenaline