Choking and Anaphylaxis

Question 1

What do the resus guidelines state for mild airway obstruction?

Severe obstruction?

• conscious
• unconscious

Answer 1

Mild airway obstruction - remain conscious

• Encourage pt to cough
• back blows and abdominal thrusts can do more harm

Severe airway obstruction - unable to cough/breathe

Conscious: 5 back blows between shoulder blades, 5 abdominal thrusts, phone 999 and continue back blows and thrusts

Unconscious - start CPR

Question 2

What is anaphylaxis?

Characterised by?

Causes?

Answer 2

Anaphylaxis - severe and life threatening generalised hypersensitivity reaction

• characterised by rapidly developing Airway and/or Breathing and/or Circulation problems
• usually with skin/mucosal changes

Causes in UK:

• stings, food, antibiotics, anaesthetics, contrast media, other drugs

Question 3

How should you recognise and treat anaphylaxis?

Answer 3

• ABCDE approach
• cal for help early - oxygen and adrenaline
• treat life-threatening problems

Question 4

List some symptoms associated with Airway and anaphylaxis:

Answer 4

Airway:

• swelling - throat and tongue
• difficulty breathing and swallowing
• sensation of throat closing up
• hoarse/stridor voice

Question 5

List some symptoms associated with Breathing and anaphylaxis:

Answer 5

Breathing:

• feel short of breath
• increased resp rate
• wheeze
• fatigue
• hypoxia
• confusion
• eventually cyanosis and respiratory arrest

Question 6

List some symptoms associated with Circulation and anaphylaxis:

Answer 6

Circulation:

• signs of shock, pale clammy
• tachycardia
• hypotension
• faintness
• drowsiness
• eventually cardiac arrest

Question 7

List some symptoms associated with Disability and anaphylaxis:

Exposure:

Answer 7

Disability:

• sense of impending doom and panic
• reducing conscious level due to ABC problems

Exposure:

• skin changes (often first feature)
• erythema - patchy red rash
• urticaria - swollen red rash
• angiodema - swelling of mucosal tissues (throat, eyes, lips)

Question 8

How is anaphylaxis managed?

Answer 8

• phone 999
• secure airway - head tilt, jaw thrust, chin lift
• high flow oxygen 15L/min
• IM adrenaline - repeat after 5 mins if no better
• CPR if unresponsive and not breathing normally
• chlorphenamine, hydrocortisone, IV fluids - once expertise and meds available

Question 9

What is the dose of IM adrenaline for anaphylaxis in:

• 0-6yrs:
• 6-12 yrs:
• >12yrs/adults:

Answer 9

• 0-6yrs: 150mcg
• 6-12 yrs: 300mcg
• >12yrs/adults: 500mcg