Anaphylaxis

Question 1

What are some signs of anaphylaxis?

Answer 1

Uritcarial rash / skin reaction
Angioedema of the eyes or lips 
Conjunctival injection
Laryngoedema causing stridor, breathing difficulties 
Bronchospasm causing cough 
Tachycardia 
Hypotension 
Shock

Question 2

What are some common precipitants for anaphylaxis?

How long does it take for reaction to happen?

Answer 2

The most common allergens include:

• Peanuts or other nuts
• Seafood
• Insect bites (especially wasps and bee stings)
• Drugs and IV injections e.g. antibiotics, NSAIDs, iron, heparin)

Symptoms start within 30 mins of exposure if ingested, 5 mins if IV!!!!

Question 3

How do we manage a case of anaphylaxis?

Answer 3

A-E approach
CRASH BUZZER OF 2222

• LIE THE PATIENT DOWN if hypotensive (preserve blood flow to brain)
• MANAGE AIRWAY - consider intubation / ventilation if necessary or emergency cricothyrotomy with 14G needle. 100% O2
• STOP THE CAUSING AGENT

1. ADRENALINE 0.5mg (0.5ml) 1 in 1000 vasoconstrictor, decreased vascular permeability and improves contractility - overcome shock
2. START FLUIDS (500mL NaCl)
3. IV CHLORPHENAMINE 10mg - anti-histamine that will help regulate the inflammatory response and reverse vasodilation
4. IV HYDROCORTISONE 200mg (slower acting)

CALL SENIOR HELP

Question 4

What dose of adrenaline should be given. How often can it be repeated?
How should you give it?

Answer 4

Always give IM unless experienced with IV
1 in 1000 adrenaline 500mcg (or 0.5 mg) to adult or child above 12

A repeat dose can be given in 5 minutes if there is no response

Question 5

How long should patients be monitored for?

Why?

Answer 5

OBSERVED FOR MINIMUM OF 6 HOURS

-Risk of biphasic reaction within 6 hours

Question 6

How do the doses of adrenaline differ from adults and children? (anaphylaxis)

Answer 6

ADRENALINE DOSES

• Adult or child older than 12years give 500micrograms (0.5ml)
• Child 6-12 years give 300 micrograms (0.3ml)
• Child less than 6 years give 150 micrograms (0.15ml)