Intervention

Question 1

Step 1: Assess for Signs & Symptoms

Answer 1

circulation, airway and breathing of a client suffering from anaphylaxis should be assessed systematically and appropriate interventions commenced immediately. Appropriate interventions may include basic life support such as opening and positioning of the airway, supporting ventilation with a bag-valve mask, or chest compressions.

Question 2

Step 3: Administer Epinephrine

Answer 2

Epinephrine works by:

Acting on smooth muscle of the bronchial tree to reduce bronchospasm
Counteracting histamine-induced vasodilation
Increasing cardiac output
Reducing histamine release

Adults should receive epinephrine 0.5 mg IM as an initial dose and for any subsequent doses.
Children up to 50 kg should receive epinephrine 0.01 mg/kg IM to a maximum of 0.5 mg as an initial dose and for any subsequent doses.
Children over 50 kg should receive epinephrine 0.5 mg IM as an initial dose and for any subsequent doses.
For children where weight is unknown, use dose by age

Question 3

Step 5: Place in Recumbent Position, Legs Elevated

Answer 3

The significant vasodilation that can occur with anaphylaxis decreases the amount of blood returning to the heart. Placing the client recumbent with legs elevated may promote better blood return to the heart. Death can occur if a client stands or sits up suddenly.

If respiratory distress is present, place the client in a position of comfort. This will usually be semi-reclined.

Consider placing vomiting clients on their side to help protect their airway, especially if they have an altered level of consciousness. Pregnant clients should be placed on their left side.

Question 4

Step 6: Administer Oxygen

Answer 4

Anaphylaxis can cause bronchospasm and mucous production that can lead to hypoxia.

Administer supplemental oxygen if available, via nasal prongs (1-6L/min) or oxygen mask (5-10L/min), with the goal of maintaining oxygen saturation above 92%

Question 5

Step 7: Continuous Observation

Answer 5

Observe continuously and assess vital signs every 5 minutes.
Clients suffering from anaphylaxis can deteriorate rapidly and must be continuously observed. The adequacy of the client’s circulation, breathing and airway should be monitored continually and appropriate interventions performed if indicated.

Question 6

Step 8: Repeat Epinephrine

Answer 6

IM epinephrine should be repeated every 5 minutes PRN for a maximum of 3 total doses (including initial dose) if the signs and symptoms of anaphylaxis are becoming worse, or have not resolved.

Many clients (up to 30%) require at least two doses of IM epinephrine during initial emergency treatment

Question 7

Step 9: Initiate IV Access

Answer 7

Anaphylaxis can cause significant vasodilation, requiring fluid resuscitation.