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Flashcards in Management Acute Deck (16)
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1

What is anaphylaxis

Life threatening severe type 1 allergic reaction
- IgE responds inappropriately to allergen causing release of histamine and other substances

2

How does it present

80% present rash + angiooedema but 20% don't

Sudden onset rapid progression of Sx
Skin / mucosal change
- Erythema - patchy or generalised red rash
- Urticaria (Hives)
- Flushing
- Itch
- Angio-oedema - similar to urticaria but swelling of deeper tissue e.g. eyes / mouth but sometimes airway
Upper airway oedema and bronchospasm - common in asthmatics
Abdo pain
N+V
Indicative of anaphylaxis = airway / breathing compromise
- Stridor
- Wheeze
- Tachycardia
- SOB
- Collapse
- Hypotension

3

How do you treat

ABCDE
- O2, IV access, fluid bolus etc
- 500ml adult saline
- 20 ml / kg child saline
Call 2222 - consider anaesthetist if think airway compromised
Remove trigger
If breathing normal = lie flat and raise head
If breathing compromised = sit up and monitor
Adrenaline IM anterolateral aspect of mid thigh
Repeat every 5 minutes even if detioerrate
Hydrocortisone IV
Chloroamphetamine IV
Can give salbutamol if wheezing

4

Doses adrenaline

1 in 1000
>12 = 0.5ml
6-12 = 0.3ml
<6 = 0.15ml

5

Doses hydrocortisone

200mg >12
100mg >6-12
50 mg >6 months-6
25mg <6 months

6

Doses chloroamphetamine

10mg >12
5mg 6months-12
2.5mg <6months

7

What may be needed

Intubation

8

What can be taken after to prove anaphylaxis

Serum typrtase

9

What must you do after an episode of anaphylaxis

Observe patient for 6-12 hours incase biphasic reaction occurs
Observe 24 hours if severe reaction, severe asthma, allergen trigger still present, previous Hx of biphasic reaction
Teach about epipen
Refer to allergic clinic

10

What does of adrenaline in rests

1 in 10,000 10ml IV

11

Cardiac arrest

OK

12

Common drugs causing anaphylaxis

Anaesthetic
Muscle relaxant
Ax
NSAID / aspirin

13

If bee sting has caused reaction what is important to do

Remove

14

What are the Ddx to consider of anaphylaxis

Asthma
- Use Adrenaline first as will treat both
- Use inhaler / nebuliser
Septic shock
- Hypotension with purpuric rash
- Sepsis 6
Other
- Vasovagal
- Panic attack
- Idiopathic urticaria

15

If patient states struggling to breath and hoarse voice / closing up

IM adrenaline ASAP

16

If hypotensive

Lie flat and raise legs