M16 - Anaphylaxis And Allergic Reactions

Question 1

Allergic reactions occur in a spectrum from mild _____ to _____ with major _____ and/or ______ compromise. ______ is an acute life threatening reaction characterised by a rapidly deteriorating _____ and/or _____ and/or ______ problems.

Answer 1

Allergic reactions occur in a spectrum from mild URTICARIA to ANAPHYLAXIS with major PULMONARY and/or CARDIOVASCULAR compromise. ANAPHYLAXIS is an acute life threatening reaction characterised by a rapidly deteriorating AIRWAY and/or BREATHING and/or CIRCULATION problems.

Question 2

Patients who present with signs and symptoms of _____ or have been administered ____ either prior to paramedic arrival or by the attending paramedics for ______:

• Must not be allowed to ___ or ____ at any time, and
• Must be positioned ____ unless ____ _____ are present, in which case the patient may be permitted to ____ on the stretcher with their legs ____, and
• Must be transported to hospital via _____

Answer 2

Patients who present with signs and symptoms of ANAPHYLAXIS or have been administered ADRENALINE either prior to paramedic arrival or by the attending paramedics for ANAPHYLAXIS:

• Must not be allowed to STAND or WALK at any time, and
• Must be positioned SUPINE unless BREATHING PROBLEMS are present, in which case the patient may be permitted to SIT on the stretcher with their legs OUTSTRETCHED, and
• Must be transported to hospital via STRETCHER

Question 3

Paramedics should obtain a history of _____ to known ____ e.g. medication, food, or insect bite/sting. Symptoms consistent with allergic reaction in the context of ____ to known allergens increases the ____ of symptoms being due to allergy, however the ____ of exposure to known allergens does not exclude allergy or anaphylaxis.

Answer 3

Paramedics should obtain a history of EXPOSURE to known ALLERGENS e.g. medication, food, or insect bite/sting. Symptoms consistent with allergic reaction in the context of EXPOSURE to known allergens increases the LIKELIHOOD of symptoms being due to allergy, however the ABSENCE of exposure to known allergens does not exclude allergy or anaphylaxis.

Question 4

It is vital to first perform a full ____ ____ of any patient suspected of having an anaphylactic or allergic reaction, to detect any ______ features or those that need immediate intervention to prevent _____.

Answer 4

It is vital to first perform a full PRIMARY SURVEY of any patient suspected of having an anaphylactic or allergic reaction, to detect any LIFE-THREATENING features or those that need immediate intervention to prevent DETERIORATION.

Question 5

Anaphylaxis signs and symptoms
Any one or more of the following signs and symptoms may indicate anaphylaxis. The signs and symptoms of mild to moderate allergic reactions are not always present in anaphylaxis.
- Difficult/noisy \_\_\_\_\_
- Difficulty \_\_\_\_ and/or \_\_\_\_\_ voice
- \_\_\_\_\_ of the tongue
- Persistent \_\_\_\_\_ or \_\_\_\_\_
- \_\_\_\_/\_\_\_\_\_ in throat
- \_\_\_\_ and \_\_\_\_ (young children)
- \_\_\_\_\_ or persistent \_\_\_\_

Answer 5

Anaphylaxis signs and symptoms
Any one or more of the following signs and symptoms may indicate anaphylaxis. The signs and symptoms of mild to moderate allergic reactions are not always present in anaphylaxis.
- Difficult/noisy BREATHING
- Difficulty TALKING and/or HOARSE voice
- SWELLING of the tongue
- Persistent DIZZINESS or COLLAPSE
- SWELLING/TIGHTNESS in throat
- PALE and FLOPPY (young children)
- WHEEZE or persistent COUGH

Question 6

Mild to moderate allergic reaction signs and symptoms
Patients may show some or all signs and symptoms below:
- _____ of lips, face, eyes
- ______
- ____ or welts
- _____ pain
- ____ mouth
- Note that ___ ____ and ____ are signs of ____ for ___ medications and ____ ___/___

Answer 6

Mild to moderate allergic reaction signs and symptoms
Patients may show some or all signs and symptoms below:
- SWELLING of lips, face, eyes
- VOMITING
- HIVES or welts
- ABDOMINAL pain
- TINGLING mouth
- Note that ABDOMINAL PAIN and VOMITING are signs of ANAPHYLAXIS for INJECTED medications and INSECT BITES/STINGS

Question 7

____ ______ is the front line treatment for ALL patients with _____ reactions. All patients with ____ must be administered ____. If in doubt, treat as ____.

If signs and symptoms of _____ are present, patients should be administered a _____ dose of _ _ _. If the patient deteriorates into ____ ____ a further ____ of _ _ _ should be administered irrespective of ___ ____.

Answer 7

IM ADRENALINE is the front line treatment for ALL patients with ANAPHYLACTIC reactions. All patients with ANAPHYLAXIS must be administered ADRENALINE. If in doubt, treat as ANAPHYLAXIS.

If signs and symptoms of HYPOVOLAEMIA are present, patients should be administered a BOLUS dose of COMPOUND SODIUM LACTATE. If the patient deteriorates into CARDIAC ARREST a further BOLUS of COMPOUND SODIUM LACTATE should be administered irrespective of PREVIOUS ADMINISTRATION.

Question 8

Medication for mild allergic reaction

Answer 8

Fexofenadine (235)
>= 12 yo
180mg PO
No repeat, max 1 dose

Question 9

Medication for anaphylaxis

Answer 9

1. Adrenaline 1:1,000 - IM (201)
   >=16yo: 500mcg IM, repeat 5 min, no max
   <16yo: 10mcg/kg IM (max bolus 500mcg), repeat 5 min, no max
2. Compound Sodium Lactate (211) - if signs of hypovolaemia present
   All ages: 20mL/kg IV bolus, repeat whilst indicated.
   Repeat bolus dose if deterioration to cardiac arrest.
3. Salbutamol (216) - for persistent wheeze
   >=5yo: 5mg NEB, repeat whilst indicated
   <5yo: 2.5mg NEB, repeat whilst indicated
4. Adrenaline infusion (201) - Unresponsive to 4x IMI adrenaline
   >=16yo: 1mg (10mL) 1:10,000 diluted in 90mL CSL via burette with microdrip. Commence 5mcg/min (30dpm) titration to effect whilst indications persist.