Flashcards in Emergency treatment of anaphylaxis in infants and children Deck (23):
What is anaphylaxis?
Severe, acute and potentially life-threatening medical condition caused by systemic release of mediators from mast cell and basophils often in response to an allergen with rapid onset
What are CNS symptoms of anaphylaxis?
Fussiness, irritability, drowsiness, lethargy, reduced level of consciousness, somnolence
What are skin symptoms of anaphylaxis?
Urticaria, pruritus, angioedema, flushing
What % of children with anaphylaxis have cutaneous manifestations?
What are some airway symptoms of anaphylaxis?
Upper: Stridor, hoarseness, oropharyngeal or laryngeal edema, uvular edema, swollen lips/tongue, sneezing, rhinorrhea, upper airway obstruction
Lower: Coughing, dyspnea, bronchospasm, tachypnea, respiratory arrest
What % of children with anaphylaxis have respiratory involvement?
What are some cardiovascular symptoms of anaphylaxis?
Tachycardia, hypotension, dizziness, syncope, arrhythmias, diaphoresis, pallor, cyanosis, cardiac arrest
What % of children with anaphylaxis have cardiovascular involvement?
What are some gastrointestinal symptoms of anaphylaxis?
Nausea, vomiting, diarrhea, abdominal pain
What is the clinical criteria for diagnosis of anaphylaxis?
Any one of the following three criteria:
1. Acute onset of an illness with involvement of the skin, mucosal tissue or both and at least one of the following:
a. Respiratory compromise
b. Reduced BP or associated symptoms of end-organ dysfunction
2. Two or more of the following that occur rapidly after exposure to a likely allergen for that patient:
a. involvement of the skin-mucosal tissue
b. respiratory compromise
c. reduced BP or associated symptoms of end-organ dysfunction
d. persistent GI symptoms
3. Reduced BP after exposure to a known allergen for that patient
a. Infants and children: low sBP or >30% decrease in sBP
What epipen should be prescribed?
1. 10-25kg Epipen JR (0.15mg)
2. >25kg Epipen (0.3mg)
<10kg make decision epipen JR vs. syringes
What is the first line therapy of anaphylaxis?
epinephrine 1:1000 0.01mg/kg IM lateral thigh every 5-15min if symptoms persist
What are the second line pharmacologic therapies?
1. PO/IV H1 antagonist - benadryl 1mg/kg (max 50mg) IV/PO or cetirizine PO
2. H2 antagonist - ranitidine 1mg/kg (max 50mg) IV/PO
3. Steroids - prednisone 1mg/kg (max 75mg) PO or methylprednisolone 1mg/kg (max 125mg) IV
4. Salbutamol for bronchospasm
What is the management for hypotension?
IV NS bolus 20mL/kg
If persistent epinephrine 0.1-1ug/kg/min IV infusion
What manifestations are H1/H2 blockers effective for?
What is an option for patients on beta-blockers?
Glucagon 20-30ug/kg IV over 5min, then 5-15ug/min IV infusion
When can a biphasic reaction occur?
1-72h after onset
What % of patients with anaphylaxis experience a biphasic reaction?
What is the minimum recommended observation period?
When should a child be admitted to hospital?
1. Live far from medical care
2. Required repeated doses of epinephrine
3. Initial presentation with hypotension or severe respiratory distress
4. Biphasic reaction
5. Consider in patient with peanut allergy, asthma, or use of beta-blockers
What are risk factors that may indicate the need to prescribe self-injectable epinephrine?
1. Reaction to trace allergen exposure
2. Repeat exposures likely
3. Specific food triggers known to be associated with severe/fatal reactions i.e. peanut, tree nut, seafood, or milk
4. Generalized urticaria from insect venom
6. Use of non-selective beta-blockers
7. Initial reaction details unclear, possible anaphylaxis
8. Those living in a remote area away from medical care/access
What medications other than epinephrine can be prescribed at discharge?
1. Cetirizine (oral H1 antihistamine) x 3d
2. Ranitidine (oral H2 antihistamine) x 3d
3. Oral corticosteroids