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1/ Anaphylaxis Tweetorial
Anaphylaxis:
Sudden onset of symptoms
Rapid progression of symptoms.
Airway, Breathing &/or Circulation problems distinguish it from a milder allergic reaction.
i.e. Wheeze, Laryngeal Oedema, Hypotension.
Skin signs are not always present.
Anaphylaxis:
Sudden onset of symptoms
Rapid progression of symptoms.
Airway, Breathing &/or Circulation problems distinguish it from a milder allergic reaction.
i.e. Wheeze, Laryngeal Oedema, Hypotension.
Skin signs are not always present.
2/ Fatal anaphylaxis:
Reactions are fast:
Food -> respiratory arrest after 30 minutes
Insect stings -> hypotensive shock after 10–15 mins
iv medication -> within five minutes.
Don't undertreat anaphylaxis with wheeze; get the Adrenaline in early.
Reactions are fast:
Food -> respiratory arrest after 30 minutes
Insect stings -> hypotensive shock after 10–15 mins
iv medication -> within five minutes.
Don't undertreat anaphylaxis with wheeze; get the Adrenaline in early.
3/ Posture: this is so important ( whether in the community or in hospital).
Changes in posture: supine to upright or semi-recumbent have been associated with cardiovascular collapse and fatal outcome during anaphylaxis.
(Yup I know I can't draw!)
Changes in posture: supine to upright or semi-recumbent have been associated with cardiovascular collapse and fatal outcome during anaphylaxis.
(Yup I know I can't draw!)
4/ Treatment:
IM Adrenaline
Every 5 minutes until symptoms resolve.
IM Adrenaline
Every 5 minutes until symptoms resolve.
If more than 2 doses needed think refractory anaphylaxis.
(IV Adrenaline - if you are an expert)
IM Adrenaline
Every 5 minutes until symptoms resolve.
IM Adrenaline
Every 5 minutes until symptoms resolve.
If more than 2 doses needed think refractory anaphylaxis.
(IV Adrenaline - if you are an expert)
5/ IV fluids
We often under administer fluids.
If hypotension is dominating be generous (see guidelines for specifics of which fluid when).
Rapid IV fluid bolus: 500-1000 mL in an adult
A large volume (up to 3-5 litres) may be needed for
severe anaphylactic shock.
We often under administer fluids.
If hypotension is dominating be generous (see guidelines for specifics of which fluid when).
Rapid IV fluid bolus: 500-1000 mL in an adult
A large volume (up to 3-5 litres) may be needed for
severe anaphylactic shock.
6/ What about corticosteroids and antihistamines?
Both are no longer recommended acutely.
But consider steroids in food allergic pats with asthma.
Severe angioedema; for symptomatic relief
And Antihistamines for skin signs.
Oral Cetirizine preferred to iv Chlorphenamine.
Both are no longer recommended acutely.
But consider steroids in food allergic pats with asthma.
Severe angioedema; for symptomatic relief
And Antihistamines for skin signs.
Oral Cetirizine preferred to iv Chlorphenamine.
7/
Once cardiac arrest has occurred, absorption of adrenaline given IM will not be reliable and attempts to give it may interrupt CPR. Use doses of intravenous/intraosseous (IV/IO) adrenaline as per ALS
Don't give up! Prolonged resuscitation may be successful
Once cardiac arrest has occurred, absorption of adrenaline given IM will not be reliable and attempts to give it may interrupt CPR. Use doses of intravenous/intraosseous (IV/IO) adrenaline as per ALS
Don't give up! Prolonged resuscitation may be successful
8/ Follow-up
Refer to an allergy specialist.
If the allergen cannot easily be avoided e.g. food/stings prescribe an Adrenaline autoinjector (AAI) & don't wait for the allergist to do so. Esp post-COVID, wait for appts may be longer than normal.
TRAIN pats how to use their AAI.
Refer to an allergy specialist.
If the allergen cannot easily be avoided e.g. food/stings prescribe an Adrenaline autoinjector (AAI) & don't wait for the allergist to do so. Esp post-COVID, wait for appts may be longer than normal.
TRAIN pats how to use their AAI.
9/
@ResusCouncilUK have launched the 2021 draft of 'Emergency treatment of anaphylaxis guidelines for healthcare providers' for public consultation.
Here is the link. https://www.resus.org.uk/about-us/news-and-events/2021-draft-anaphylaxis-consultation
@ResusCouncilUK have launched the 2021 draft of 'Emergency treatment of anaphylaxis guidelines for healthcare providers' for public consultation.
Here is the link. https://www.resus.org.uk/about-us/news-and-events/2021-draft-anaphylaxis-consultation
