Anapyhlaxis (Complete)

Question 1

What are the main features of anaphylaxis?

Answer 1

SoB

Wheeze

Stridor

Facial swelling

Throat and toungue swelling

Hoarseness

Hypotension

Tacchycardia

Generalised pruritus

Widespread erythematous or urticarial rash

Question 2

How is acute anaphylaxis managed?

Answer 2

1) Administer 500microgram adrenaline (1:1000) IM at the anterolateral aspect of the middle third of thigh

2) Repeat every 5 minutes

3) IV fluids and expert input if cardioresp symptoms persist after 2 doses of IM

4) Consider IV adrenaline infusion after expert help seeked

Question 3

Anaphylaxis that persists after 2 doses of IM is considered as?

Answer 3

Refractory anaphylaxis

Question 4

How is refractory anaphylaxis managed?

Answer 4

IV fluids

Expert input for IV adrenaline infusion

Question 5

What is post-acute management of anaphylaxis?

Answer 5

Referal to allergy clinic (if new anaphylaxis)

Conservative:

2 adrenaline auto-injectors: Given on standby and as inteim until allergy clinic assesment

Patient taught on how to administer IM injection

Medicine:

Chlorphenamine (non-sedating anti-histamine)

2 adrenaline auto-injectors: Given on standby and as inteim until allergy clinic assesment

Question 6

When should anaphylactic patients be reffered to allergy clinic?

Answer 6

If this is their first episode of anaphylaxis

Question 7

What medication can be given after post-acute management if patient is still experiencing skin symptoms?

Answer 7

Non-sedating antihisatmines (E.g. chloramphenicol)

Question 8

What patients be considered for discharge after 2 hours of symptom resolution?

Answer 8

Patients with fully resolved symptoms after 1 IM injection

Have been given auto-injectors and trained adequately

Have adeqaute supervision/follow-up post-discharge

Question 9

What patients can only be considered for discharge after 6 hours minimum of symptom resolution?

Answer 9

Patient had a previous biphasic reaction

Patient required 2 doses of IM

Question 10

What patients can only be considered for discharge after 12 hours minimum of symptom resolution?

Answer 10

> 2 IM doses

Pmx of severe asthma

Possibility of a ongoing anaphylaxis (e.g. if taking a slow-release medication that triggered allergy)

Patient presents late at night

Patient in areas where emergency access limited