DRABCDE managing anaphylaxis

Question 1

Clinical setting: You are clerking a patient on a surgical ward when you hear someone call for help. The nurse tells you that Mrs. Stevens (34 yrs) has become acutely short of breath and feels very unwell after her second dose of IV antibiotics for a wound infection. Please assess and treat the patient.

Latest observations: HR 120, BP 80/ 40, RR 26, Sats 85% on air, Temp 37.8

management of anaphylaxis is based on the standard DRABCDE. — D and R steps

Answer 1

D Washes hands, safe to approach.
R Patient is responsive but not completing sentences.(Considers anaphylaxis treatment)

as soon as it looks bad, pull the red alarm by the bed, call for help and get someone to call the PERT team.

Question 2

management of anaphylaxis is based on the standard DRABCDE. - airway assessment

Answer 2

remember - look, feel, listen, measure, treat, repeat

Airway :

Look- Swollen lips and tongue.
Feel - Feels air on cheek
Listen - Noisy breathing/ stridor.
Measure - Sats 85% on air, RR 26.
Treat - O2, considers adjunct/ positioning. (Gives adrenaline ASAP.)

• stop whatever might be causing the problem, in this case the IV antibiotics.
• adrenaline 0.5mg IM into anterolateral aspect of the thigh (0.5ml of 1 in 1000). repeat every 5 mins as guided by resp and cardio vitals. the injections often come as 1ml so dispose of 0.5ml first.
• attach 15l/min oxygen in a non-rebreathe mask.
• if wheeze then treat as asthma with salbutamol 5mg NEB
• if complete circulatory collapse and IV adrenaline needed then the dose is 100 micrograms per min, titrate with response= 0.5ml of 1 in 10,000 per min. if on beta blocker then consider IV salbutamol.

Question 3

management of anaphylaxis is based on the standard DRABCDE. - breathing assessment

Answer 3

remember - look, feel, listen, measure, treat, repeat

Breathing:

Look - Flushed, central trachea, reduced chest movement.
Feel - Symmetrical but shallow chest movement, nil on percussion.
Listen - Wheeze throughout.
Measure - RR 26, Sats 85% on air
Treat- Administer bronchodilator/ O2 (sats improve to 96%). ABG. CXR.

Question 4

management of anaphylaxis is based on the standard DRABCDE. - circulation assessment

Answer 4

remember - look, feel, listen, measure, treat, repeat

Circulation:

Look - Flushed, JVP not visible, no oedema.
Feel - Warm to the touch, rapid regular pulse with normal volume.

Listen - Normal heart sounds.
Measure - HR 120, BP 80/ 40, cap refill 3 secs, urine output 20mls/ hr, Temp 37.8

Treat. - 2 wide bore Cannulae, bloods (FBC/ U+E), start fluid challenge, gives steroids and antihistamine.

• possibly also flatten the bed and raise the feet to help the celebration.
• antihistamine = chlorphenamine 10mg IV
• hydrocortisone 200mg IV
• fluids = 500ml saline IV over 15 mins.

Question 5

management of anaphylaxis is based on the standard DRABCDE. - disability assessment

Answer 5

AVPU

Voice, BM 4.7mmols.

Question 6

management of anaphylaxis is based on the standard DRABCDE. - exposure

Answer 6

Flushed, sweaty, all over body rash.
Full systems examination. Write notes/charts, looks in medical notes, handover

if vitals are not improving then the specialist help is really needed and may need ITU admission.