|
|
| Line 1: |
Line 1: |
| ==Management==
| |
| Shown below is an algorithm summarizing the approach to <nowiki>[[Anaphylaxis]]</nowiki>.
| |
|
| |
|
| {{familytree/start |summary=PE diagnosis Algorithm.}}
| |
| {{familytree | | | | | | | | A01 |A01=<div style="float: left; text-align: left; height: 30 em; width: 30 em ">'''Characterize the symptoms & signs:''' <br> Skin, subcutaneous tissue and mucosa: <br> ❑ Flushing, itching, urticaria, angioedema, rash, piloerection <br> ❑ Periorbital itching, erythema and edema; conjunctival erythema, tearing <br>
| |
| ----
| |
| Respiratory: <br> ❑ Nasal itching, congestion, rhinorrhea, sneezing <br> ❑ Throat itching and tightness, dysphonia, hoarseness, stridor, dry staccato cough <br> ❑ Tachypnea, dyspnea,chest tightness, wheezing/bronchospasm <br> ❑ Cyanosis <br> ❑ Respiratory arrest <br>
| |
| ----
| |
| Gastrointenstinal: <br> ❑ Pain, nausea, vomiting, diarrhea <br>
| |
| ----
| |
| Cardiovascular: <br> ❑ Chest pain, tachycardia, palpitations <br> ❑ Hypotension, feeling faint <br> ❑ shock <br> ❑ Cardiac arrest <br>
| |
| ----
| |
| Central nervous system: <br> ❑ Anxiety, irritability <br> ❑ Throbbing headache <br> ❑ Altered vision and mental status </div>}}
| |
| {{familytree | | | | | | | | |!| | | | | | | | }}
| |
| {{familytree | | | | | | | | B01 | | | | | | | |B01=<div style="float: left; text-align: left ">'''Consider alternative diagnosis:''' <br> ❑ Acute asthma <br> ❑ Anxiety/Panic attack <br> ❑ Syncope </div>}}
| |
| {{familytree | | | | | | | | |!| | | | | | }}
| |
| {{familytree | | | | | | | | C01 | | | | | |C01=Remove patient from exposure/trigger }}
| |
| {{familytree | | | | | | | | |!| | | | | | }}
| |
| {{familytree | | | | | | | | D01 | | | | | |D01=<div style="float: left; text-align: left">Do all 3 simultaneously <br> ❑ Call for help <br> ❑ '''Inject aqueous epinephrine (adrenaline) IM in the mid-anterolateral aspect of the thigh, 0.01 mg/kg of a 1:1,000 (1 mg/mL) solution''' <br>Maximum dose 0.5 mg (adult) or 0.3 mg (child) <br> Record the time of the dose and repeat it in 5-10 minutes, if needed or <br> ❑ Intravenous epinephrine: In patients with hypotension/cardiorespiratory arrest and those not responding <br>
| |
| : 1:100,000 solution of epinephrine (0.1 mg [1 ml of 1:1000] in 100 ml saline) intravenously by infusion pump at an initial rate of 30-100 ml/hr (5-15 mg/min) <br> Titrate based on clinical response or epinephrine side effects <br>
| |
| ❑ Place patient on back/comfortable position; elevate legs</div> }}
| |
| {{familytree | | | | | | | | |!| | | | | | | }}
| |
| {{familytree | | | | E02 |-| E01 | | | | | | | |E01=<div style="float: left; text-align: left"> Patient has one of the following? <br> ❑ Respiratory distress <br> ❑ Recieved repeated doses of epinephrine <br> ❑ Asthma/other respiratory disease <br> ❑ Co-existing cardiovascular disease </div> |E02=Yes}}
| |
| {{familytree | | | | |!| | | |!| | | | | | | | }}
| |
| {{familytree | | | | F01 | | F02 | | | | | | |F01= ❑ Give high flow supplemental oxygen (6-8 L/min) |F02=No }}
| |
| {{familytree | | | | |!| | | |!| | | | | | | | }}
| |
| {{familytree | | | | |`|-|-| G01 |-| G02 | | | |G01=Patient hypotensive despite epinephrine? |G02=Yes }}
| |
| {{familytree | | | | | | | | |!| | | |!| | | | }}
| |
| {{familytree | | | | | | | | H01 | | H02 | | |H01=No |H02=<div style="float: left; text-align: left"> ❑ Establish IV access <br> ❑ Give 1-2 litres of 0.9% saline rapidly, 5-10 ml/Kg in first 5-10 mins <br> ❑ Give vasopressors (dopamine) 400mg in 500ml of 5% dextrose at 2-20 mg/kg/min to maintain a target systolic BP > 90 mm Hg </div> }}
| |
| {{familytree | | | | | | | | |!| | | |!| | | | }}
| |
| {{familytree | | | | | | | | I01 |-|-|'| | | |I01=<div style="float: left; text-align: left"> Secondary therapy after epinephrine '''(evidence not clear)''' <br> H1 antihistaminics: <br> ❑ Diphenhydramine IM or slow intravenous infusion - 25 to 50 mg in adults, and 1 mg/kg up to 50 mg in children
| |
| ----
| |
| H2 antihistaminics: <br> ❑ Ranitidine - 1 mg/kg in adults, and 12.5 to 50 mg in children IV or IM </div>}}
| |
| {{familytree | | | | | | | | |!| | | | | | | | }}
| |
| {{familytree | | | | | | | | J01 | | | | | | |J01=<div style="float: left; text-align: left"> ❑ Observe the patient for biphasic anaphylaxis <br>
| |
| : Total period of observation depends on <br> a) clinical condition <br> b) patients access to emergency care setting from home <br>
| |
| ❑ Provide auto-injectable epinephrine and action plan for future events at discharge </div> }}
| |
| {{familytree/end}}
| |