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Paeds - Unwell Child > Anaphylaxis > Flashcards

Anaphylaxis Flashcards

1
Q

How could you define anaphylaxis?

A

Multi-systemic allergic reaction characterised by:

  1. At least one respiratory or cardiovascular feature and
  2. At least one gastrointestinal or skin feature
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2
Q

Who are some high risk groups for developing anaphylaxis?

A
  • Hx of anaphylaxis
  • Multiple food and drug allergy
  • Poorly controlled asthma
  • Underlying lung disease
  • Beta-blockers/ACE inhibitors
  • Older age
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3
Q

What are some features of mild-moderate anaphylactic reaction?

A
  • Swelling of lips, face, eyes
  • Hives or welts
  • Tingling mouth
  • Abdominal pain, vomiting (these are signs of anaphylaxis for insect allergy)
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4
Q

What are some features of severe anaphylactic reaction?

A
  • Difficult/noisy breathing
  • Swelling of tongue
  • Swelling/tightness in throat
  • Wheeze or persistent cough
  • Difficulty talking and/or hoarse voice
  • Persistent dizziness or collapse
  • Pale and floppy (young children)
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5
Q

What are some respiratory symptoms of anaphylaxis?

A
  • Tongue swelling
  • Stridor
  • Hoarse voice or change in character of the cry
  • Subjective feeling of swelling or tightness/tingling in the throat
  • Persistent cough
  • Wheeze
  • Dysphagia
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6
Q

What are some CV symptoms of anaphylaxis?

A
  • Pale and floppy infant
  • Palpitations
  • Tachycardia
  • Bradycardia
  • Hypotension
  • Cardiac arrest
  • Altered consciousness/confusion
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7
Q

What are some GI symptoms of anaphylaxis?

A
  • Nausea
  • Vomiting
  • Diarrhoea
  • Abdominal/pelvic pain
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8
Q

What are some mucocutaneous symptoms of anaphylaxis?

A
  • Generalised pruritus
  • Urticaria/ intense erythema
  • Conjunctival erythema and tearing
  • Flushing
  • Angioedema
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9
Q

What are some neurological symptoms of anaphylaxis?

A
  • Headache (usually throbbing)
  • Dizziness
  • Confusion
  • Collapse with or without unconsciousness
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10
Q

What types of epipen are there?

A

EpiPen® (300mcg) is prescribed for children over 20kg and adults. EpiPen Jr® (150mcg) is prescribed for children 10-20kg

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11
Q

What is the community Mx of anaphylaxis?

A
  1. Remove allergen if possible
  2. Lay person flat - do NOT allow them to stand or walk
    • If unconscious, place in recovery position
    • If breathing is difficult allow them to sit
  3. Give EpiPen® or EpiPen® Jr adrenaline autoinjector
  4. Phone ambulance
  5. Phone family/emergency contact
  6. Further adrenaline doses may be given if no response after 5 minutes
  7. Transfer person to hospital for at least 4 hours of observation
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12
Q

In the hospital, what is the dose of adrenaline given, where, and how often?

A
  • Intramuscular 0.01mg/kg i.e. 1:1000 (max 0.5mg)
  • If unknown weight: <6 = 0.15ml, 6-12 = 0.3ml, >12 = 0.5ml
  • Anterior-lateral thigh
  • Repeat after 5 minutes if not improving
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13
Q

In the hospital, what measures should be made during the primary survey for anaphylaxis?

A
  • DRS
  • Airway:
    • partial obstruction: IM Adr, Adr 5ml nebs, high flow O2
    • complete obstruction: bag mask, LMA, intubation, surgical arway
  • Breathing:
    • high flow O2, 1:1000 adrenaline
  • Circulation: posture (elevate legs), resusc fluids, ALS
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14
Q

What is the role of injectable promethazine in anaphylaxis?

A

Injectable promethazine should not be usedin anaphylaxis as it can worsen hypotension and cause muscle necrosis

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15
Q

When should you consider admission for anaphylaxis?

A
  • Greater than one dose of adrenaline
  • A fluid bolus required
  • Inadequate response to treatment
  • Child lives long distance from medical services
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16
Q

Outline some important points for discharge of post-anaphylaxis patient.

A
  • Avoid allergen triggers
  • Anaphylaxis action plan
  • Recognising symptoms
  • How to use epipen
  • Consider medical alert bracelet
  • Referral to paediatric allergy specialist
  • Patient and parent education
  • Anti-histamines may be given for symptomatic relief of pruritus
17
Q

Educate someone on how to use an epipen.

A

• Before: Check the window on the side - aclear window shows clearly if the epipen has already been used. If the window is black, do not use this epipen

  • Form a fist around the shaft of the epipen. Do not put your thumb over either end.
  • The blue to the sky, orange to the thigh
  • Take blue safety cap off
  • Push into upper outer thigh
    • The needle will automatically come out and give an injection of adrenaline
    • If child wearing clothes, go straight through pants
    • You should hear a click- hold for 10s

• After:
• Remove and massage the spot for 10 seconds
○ This makes sure at all the medicine is delivered
• Always call an ambulance after using an epipen
○ Take the epipen to hospital with you

Do not worry about an exposed needle as it is protected by the device.

Paeds - Unwell Child (16 decks)

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