Anaphylaxis

Question 1

Which A-E does this condition affect?

Answer 1

Airway

Question 2

Targeted A-E Airway

Answer 2

If low GCS or unable to maintain airway

• Stridor, angioedema
• Basic airway manoeuvres e.g. head tilt chin lift, jaw thrust
• Airway adjuncts e.g. guedel (oropharyngeal) or nasopharyngeal -
• Call anaesthetist or 2222 call peri arrest

If high suspicion of anaphylaxis at this point:
1. Stop offending agent and remove cannula
2. IM adrenaline 0.5mg 0.5ml 1:1000, give another dose after 5 mins
3. Raise legs

Question 3

Breathing

Answer 3

RR, O2 sats -> high flow O2 15L via Non-rebreath mask

Look – resp distress, tracheal tug

Listen – widespread wheeze, cyanosis, decreased breath sounds

Feel - chest expansion etc.
Consider ABG and CXR if necessary

Question 4

Circulation

Answer 4

• HR, BP - > findings hypotension
• IV access
• STAT 500ml-1000ml 0.9% NaCl fluid bolus to resus over 15 minutes

Bloods: FBC, U&Es, LFTs, CRP, mast cell tryptase (1-6 hours after suspected anaphylaxis - 2 blood sample tests ), serum IgE levels

• If still hypotensive, may need to admit to ITU
• IV chlorphenamine 10mg, IV hydrocortisone 200mg – not in current guidelines but may be considered
• Adrenaline infusion may be needed in cases of refractory anaphylaxis (no response after 2 doses of IM adrenaline)

Question 5

Disability

Answer 5

BM, GCS, PEARL
Drug chart: check for allergies

Question 6

Exposure

Answer 6

• Cannulas, lines, expose body for bee stings, urine output, abdominal examination
• Long-term: allergy testing, 0.3mg EpiPen, education, MedicAlert bracelet, skin prick test
• Safety net for biphasic reaction within 72 hours, treated the same

Question 7

Differentials

Answer 7

Stridor:
- foreign body
- peritonsillar abscess
- croup
- epiglottitis
- mass obstruction

Other acute dyspnoea:
- asthma
- IECOPD
- pulmonary oedema

Question 8

A-E findings

Answer 8

Question 9

Overall management

Answer 9