Paediatric: Anaphylaxis CPG Flowchart And Care Objectives

Question 1

Initial considerations for anaphylaxis (ceasing triggers, transport and monitoring)

Answer 1

Stop the trigger (e.g. cease infusion, remove food, wash exposed skin).

Any patient with anaphylaxis (even resolved) who has received Adrenaline must be transported to hospital.

Patients require continuous monitoring as deterioration can occur suddenly

Question 2

What are the criteria for anaphylaxis?

Answer 2

Sudden onset of symptoms (usually < 30 min or up to 4 hours)

AND

two or more of R.A.S.H. +/- confirmed exposure to antigen:
R - Respiratory distress
A - Abdominal symptoms
S - Skin/mucosal symptoms
H - Hypotension.

OR

Isolated hypotension or respiratory distress following exposure to known antigen also qualifies.

Question 3

What should you do if a patient is experiencing anaphylaxis?

Answer 3

1. Do not sit or walk the patient if possible
2. Administer Adrenaline 10 mcg/kg IM (max 60 mcg) 1:1000, repeat at 5 minute intervals as required.
3. Request MICA if risk factors met or not responsive to adrenaline
4. High flow oxygen

Question 4

What is the first therapy to prioritise in cases of airway oedema or stridor?

Answer 4

Adrenaline 5 mg nebulised

Consult AV Medical Advisor via AV Clinician for repeat dose if required and notify receiving hospital.

Question 5

What is the repeat dosing interval for Salbutamol in cases of bronchospasm?

Answer 5

Repeat at 20-minute intervals if required.

Question 6

What is the nebulised and PMDI dose of Salbutamol for 12-15 years?

Answer 6

5 mg Neb
4-12 doses

Question 7

What is the nebulised and pMDI dose of Salbutamol for 2-5 years?

Answer 7

2.5mg neb
2 - 6 doses

Question 8

What is the nebulised and pMDI dose of Ipratropium Bromide for 12-15 years?

Answer 8

500 mcg neb
6 doses

Question 9

What is the pMDI and nebulised dose of Ipratropium Bromide for 6-11 years?

Answer 9

8 doses
250mcg neb

Question 10

What is the maximum dose of Dexamethasone?

Answer 10

12 mg (600 mcg / kg IV / oral, IV route MICA only)

Question 11

What is the nebulised and pMDI doses of salbutamol for 6-11yrs

Answer 11

2.5-5mg neb
4-12 doses

Question 12

What is the nebulised and pMDI doses of ipratropium bromide for 2-5yrs

Answer 12

250mcg neb
4 doses

Question 13

Care objectives: anaphylaxis

Answer 13

• Adrenaline IM with minimal delay
• Airway and perfusion support
• Hospital based observation (min 4 hourly) at a minimum