Management Acute

Question 1

What is anaphylaxis

Answer 1

Life threatening severe type 1 allergic reaction

- IgE responds inappropriately to allergen causing release of histamine and other substances

Question 2

How does it present

80% present rash + angiooedema but 20% don’t

Answer 2

Sudden onset rapid progression of Sx
Skin / mucosal change 
- Erythema - patchy or generalised red rash 
- Urticaria (Hives) 
- Flushing 
- Itch 
- Angio-oedema - similar to urticaria but swelling of deeper tissue e.g. eyes / mouth but sometimes airway 
Upper airway oedema and bronchospasm - common in asthmatics 
Abdo pain
N+V
Indicative of anaphylaxis = airway / breathing compromise
- Stridor
- Wheeze
- Tachycardia
- SOB
- Collapse
- Hypotension

Question 3

How do you treat

Answer 3

ABCDE
- O2, IV access, fluid bolus etc
- 500ml adult saline
- 20 ml / kg child saline
Call 2222 - consider anaesthetist if think airway compromised
Remove trigger
If breathing normal = lie flat and raise head
If breathing compromised = sit up and monitor
Adrenaline IM anterolateral aspect of mid thigh
Repeat every 5 minutes even if detioerrate
Hydrocortisone IV
Chloroamphetamine IV
Can give salbutamol if wheezing

Question 4

Doses adrenaline

Answer 4

1 in 1000
>12 = 0.5ml
6-12 = 0.3ml
<6 = 0.15ml

Question 5

Doses hydrocortisone

Answer 5

200mg >12
100mg >6-12
50 mg >6 months-6
25mg <6 months

Question 6

Doses chloroamphetamine

Answer 6

10mg >12
5mg 6months-12
2.5mg <6months

Question 7

What may be needed

Answer 7

Intubation

Question 8

What can be taken after to prove anaphylaxis

Answer 8

Serum typrtase

Question 9

What must you do after an episode of anaphylaxis

Answer 9

Observe patient for 6-12 hours incase biphasic reaction occurs
Observe 24 hours if severe reaction, severe asthma, allergen trigger still present, previous Hx of biphasic reaction
Teach about epipen
Refer to allergic clinic

Question 10

What does of adrenaline in rests

Answer 10

1 in 10,000 10ml IV

Question 11

Cardiac arrest

Answer 11

OK

Question 12

Common drugs causing anaphylaxis

Answer 12

Anaesthetic
Muscle relaxant
Ax
NSAID / aspirin

Question 13

If bee sting has caused reaction what is important to do

Answer 13

Remove

Question 14

What are the Ddx to consider of anaphylaxis

Answer 14

Asthma 
- Use Adrenaline first as will treat both
- Use inhaler / nebuliser 
Septic shock
- Hypotension with purpuric rash
- Sepsis 6 
Other
- Vasovagal
- Panic attack
- Idiopathic urticaria

Question 15

If patient states struggling to breath and hoarse voice / closing up

Answer 15

IM adrenaline ASAP

Question 16

If hypotensive

Answer 16

Lie flat and raise legs