Anaphylaxis

Question 1

What is the mechanism behind anaphylaxis?

Answer 1

IgE stimulates rapid release of histamine and other pro-inflammatory chemicals from mast cells in mast cell degranulation, causing AW, breathing and/or cirulation compromise

Question 2

Why do children have to be monitored carefully after an anaphylactic attack?

Answer 2

Biphasic reactions danger - 2nd reaction after successful treatment of first

Question 3

How is anaphylaxis confirmed after management?

Answer 3

Serum mast cell tryptase within 6 hours of events

Question 4

What to check when initially see someone with anaphylaxis?

Answer 4

Responsiveness/breathing - do they require CPR

Question 5

If someone with anaphylaxis does not require CPR what check next

Answer 5

Chest - signs of lower and upper AW obstruction
Check pulse and BP for signs of circulatory collapse
Check skin inseide moth for urticaria and angio-oedema

Question 6

Why must someone with anaphylaxis lie down and not stand up or sit up quickly>

Answer 6

Fatality can occur within minutes
Sit in semirecumbent position
Increase cerebral perfusion

Question 7

When can you put someone with anaphylaxis in the recovery position?

Answer 7

When people are breathing normally but uncosncours

Question 8

Why do pregnant women have to be put into the recovery position on their left?

Answer 8

Aortocaval compression

Question 9

What is the dose for IM adrenaline for adults or children over 12 years old?

Answer 9

500 micrograms

Question 10

When use steroids in anaphylaxis

Answer 10

just fluid and adrenaline in emergency
If later -
Slow IM or IV 200mg

Question 11

What is the emergency dose of adrenaline for children 6-12 years old?

Answer 11

1:1000, 300 micrograms - 0.3mL

Question 12

Nebulised salbutamol dose in children over 6 years to adults

Answer 12

5mg

Question 13

Salbutamol nebulised emergency dose 6 months to 6 years

Answer 13

2.5 mg

Question 14

Adrenaline emergency dose for child 6 months to 6 years

Answer 14

150 micrgrams of 1:1000

Question 15

emergency dose of adrenaline children under 6 month

Answer 15

100-150 micrograms of 1:1000

Question 16

What is the best sized needle for adrenaline administration?

Answer 16

25mm needle at right angle to skin, stretched not bunched

Question 16

What should you recognise anaphylaxis from?

Answer 16

sudden onset and rapid progression of symptoms
Airway and/or Breathing and/or Circulation problems
skin and/or mucosal changes (flushing, urticaria, angioedema)

Question 17

Where give IM adrenaline?

Answer 17

Anterolateral thigh

Question 18

When do yuo repeat IM adrenaline in anaphylaxis?

Answer 18

5 minutes and ABC problems persist

Question 19

When do you seek expert help in anaphylaxis?

Answer 19

Respiratory and/ore cardiovascular problems persist depite 2 doses of IM adrenaline -> iv ADRENALINE infusions

Question 20

What skin/mucosal changes are ass with anaphylaxis?

Answer 20

flushing, urticaria, angioedema

Question 21

When are IV fluids recommended for anaphylaxis?

Answer 21

Always
Esp in Refractor anaphyaxis, early in shock and hypotension

Question 22

What treatment is third line and should not be used in ABC initial emergency management?

Answer 22

Antihistamines and steroids

Question 23

IV fluid challenge amount in adults vs children?

Answer 23

Adult - 500-1000ml
Child - 10mL/kg

Question 24

Signs of life threatening problems with AW

Answer 24

Hoarse voice, stridor

Question 25

Breathing - signs of life threatening problems

Answer 25

Increased work of breathing, wheeze, fatigue, cyanosis, Sp02, <94%

Question 26

Steps in emergency anaphylaxis

Answer 26

A-E assess Call for help Remove trigger. lie flat IM adrenaline Establish airflow, highlow oxygen Monitoring - ECG, BP, pulse oximetry

Question 27

Symptoms of anaphylaxis

Answer 27

* Urticaria * Itching * Angio-oedema, with swelling around lips and eyes * Abdominal pain * Shortness of breath * Wheeze * Swelling of the larynx, causing stridor * Tachycardia * Lightheadedness * Collapse -Changes in bowel habit

Question 28

What is important to cover after anaphylaxis in a child?

Answer 28

Educate child and parent on trigger, how to avoid and spot signs Parents - trained in BLS and how to use adrenaline autoinjector

Question 29

What are trade names of adrenalin autoinjectors?

Answer 29

Epipen, Jext, Emerade

Question 30

What risk factors are present for autoadrenaline epipens to be given out for allergic reactions that dont cause anaphylaxis?

Answer 30

Asthma requiring inhaled steroids Poor access to medical treatment eg rural locations Adolescenets (higher risk) Nut or insect sting allergies Significant co-morbidities eg cardiovascular disease

Question 31

How to use an adrenalin autoinjector?

Answer 31

Prepare device - remove safety cap (blue or yellow, non needle end) Grip the device in fist needle down Administer injection - firmly jab by device into outer portion mid thigh until clicks 3s for EpiPen, 10s (Jext) Remove device and massage area for 10 seconds

Question 32

What do after call for help in anaphylaxis pathway

Answer 32

Remove trigger if possible Lie patient down flat or sitting ON LEFT IF PREGNANT Give IM adrenaline Establish airway Give high low oxygen Apply monitoring: pulse oximetry, ECG, BP Repeat IM adrenaline after 5 mins IV fluid bolus If no improvement after two doses -> confirm Resus team called -> REFRACTORY anaphylaxis algorithm

Question 33

Doses for IM adrenaline in anaphylaxis

Answer 33

Adult/>12 years - 500 micrograms (0.5mL) Child 6-12 years: 300 micrograms (0.3mL) Child 6 months-6 years :150 micrograms (0.15mL)w Child <6months: 100-150 micrograms (0.1-0.5mL)

Question 34

Commonest triggers for anaphylaxis

Answer 34

Peanut Tree nuts Cow's milk (children)

Question 35

What initiates pathology in anaphylaxis

Answer 35

Vasodilation and fluid extravasation

Question 36

What causes shock in anaphylaxis physiologically?

Answer 36

Hypoxia (reduced venous return -> reduced CO and bronchospasm-> reduced pulmonary blood flow) Hypotension (reduced CO and perfusion) -> Inadeuqate tissue perfusion

Question 37

Airway problems anaphylaxis

Answer 37

Airway swelling (throat and tongue swelling causing difficulty in breathing/swallowing; patients may feel their throat is closing) * Hoarse voice * Stridor (a high-pitched inspiratory noise caused by upper airway obstruction)

Question 38

Breathing problems anaphylaxis

Answer 38

Increased work of breathing * Bronchospasm (wheeze) and/or persistent cough * Patient becoming tired with the effort of breathing (fatigue) * Hypoxaemia (SpO 2 <94%) which may cause confusion and/or central cyanosis * Respiratory arrest

Question 39

Circulation problems anaphylaxis

Answer 39

Signs of shock: o pale, clammy o significant tachycardia (increased heart rate) o hypotension (low blood pressure) * Dizziness, decreased conscious level or loss of consciousness * Arrhythmia * Cardiac arrest

Question 40

When use IV or intraosseus adrenaline in anaphylaxis

Answer 40

When circulatory collapse/CPR commenced