anaphylaxis

Question 1

what do you look for?

Answer 1

• sudden onset of airway and/or breathing and/or circulation problems and usually skin changes like itchy rash

Question 1

what you do?

Answer 1

• call for help - call resusciation team or ambulance
• remove trigger if possible (e.g stop any infusion)
• lie patient flat (with or without legs elevated)
  *sitting position may make breathing easier
  *if pregnant lie on left side
• give intramuscular adrenaline into middle third of thigh
• establish airway
• give high flow oxygen
• apply ecg or pulse oximetry
• if no response repeat IM adrenaline after 5 mins
• IV fluid bolus
  -of no improvement in breathing or circulation problmes depsite 2 doses of IM adrenaline then confirm ambulance called and follow refractory anaphylaxis algorithm

Question 2

what is life threatening problems?

Answer 2

• airway
  *hoarse voice, stridor
• Breathing
  *increase work of breathing, wheeze, fatigue, cynosis, SpO2 <94%
• circulation
  *low BP, signs of shock, confusion, reduced consciousness

Question 3

what are IM adrenaline doses?

Answer 3

all 1:1000 concentration

adults and childs > 12 years - 500 micrograms
6-12 - 300 micros
6months - 6years - 150 micros
<6 months - 100-150 micros

Question 4

what is IV fluid challenge?

Answer 4

adults - 500-1000ml
children 10mL/kg