Anaphylaxis resident survival guide: Difference between revisions

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{{familytree | | | | | | | | B01 | | | | | | | |B01=<div style="float: left; text-align: left ">'''Consider alternative diagnosis:''' <br> ❑ Acute asthma <br> ❑ Anxiety/Panic attack <br> ❑ Syncope </div>}}
{{familytree | | | | | | | | B01 | | | | | | | |B01=<div style="float: left; text-align: left ">'''Consider alternative diagnosis:''' <br> ❑ Acute asthma <br> ❑ Anxiety/Panic attack <br> ❑ Syncope </div>}}
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{{familytree | | | | | | | | C01 | | | | | |C01=Remove patient from exposure/trigger }}
{{familytree | | | | | | | | C01 | | | | | |C01=Remove patient from exposure/trigger }}
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{{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> ❑ In patients with hypotension/cardiorespiratory arrest and those not responding: Intravenous epinephrine <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 </div> }}
{{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> ❑ In patients with hypotension/cardiorespiratory arrest and those not responding: Intravenous epinephrine <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> }}
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{{familytree | | | | | | | | E01 | | | | | | | |E01= Give high flow supplemental oxygen (6-8 L/min) if: <br> ❑ Respiratory distress <br> ❑ Recieved repeated doses of epinephrine <br> ❑ Asthma/other respiratory disease <br> ❑ Co-existing cardiovascular disease}}
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{{familytree | | | | | | | | | | F01 | | | F02 |F01= |F02= }}
{{familytree | | | | | | | | F01 | | | | | | | |F01= Establish IV access <br> 1-2 litres of 0.9% saline rapidly}}
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Revision as of 21:03, 15 January 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Vidit Bhargava, M.B.B.S [2]


Definition

An acute, severe, potentially life threatening type 1 hypersensitivity reaction, following repeated exposure to an allergen to which an individual is already sensitised.

Causes

Life Threatening Causes

Any of the factors precipitating anaphylaxis can be life threatening.

  • Food: Peanuts, Tree nuts, walnuts, pecans, milk, soyabean, wheat, eggs, pistachios, filberts, cashews, almonds, etc.
  • Shellfish: crab, crayfish, prawns, shrimp, lobster, etc.
  • Medications: Penicillin, Sulfa antibiotics, Allopurinol, and many other drugs
  • Diagnostic materials: IV contrast material and dyes
  • Insect venom: including bees, wasps, ants
  • Natural rubber latex
  • Idiopathic/ Coital anaphylaxis

Diagnostic Criteria

It is diagnosed with one of the following criteria:[1]
♦ Acute onset of a reaction (mins to hours) involving skin, mucous membrane or both. Additionally including atleast one of the following:

  • Respiratory compromise or
  • Cardiovascular compromise/Evidence of end organ dysfunction.

♦ 2 or more of the following in a patient known to come in contact with an established allergen:

  • Skin/mucosal tissue involvement
  • Respiratory compromise
  • Reduced blood pressure
  • Gastrointestinal manifestations

♦ Reduced blood pressure after exposure to a known allergen.

Management

Shown below is an algorithm summarizing the approach to [[disease name]].

 
 
 
 
 
 
 
Characterize the symptoms & signs:
Skin, subcutaneous tissue and mucosa:
❑ Flushing, itching, urticaria, angioedema, rash, piloerection
❑ Periorbital itching, erythema and edema; conjunctival erythema, tearing

Respiratory:
❑ Nasal itching, congestion, rhinorrhea, sneezing
❑ Throat itching and tightness, dysphonia, hoarseness, stridor, dry staccato cough
❑ Tachypnea, dyspnea,chest tightness, wheezing/bronchospasm
❑ Cyanosis
❑ Respiratory arrest


Gastrointenstinal:
❑ Pain, nausea, vomiting, diarrhea


Cardiovascular:
❑ Chest pain, tachycardia, palpitations
❑ Hypotension, feeling faint
❑ shock
❑ Cardiac arrest


Central nervous system:
❑ Anxiety, irritability
❑ Throbbing headache
❑ Altered vision and mental status
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consider alternative diagnosis:
❑ Acute asthma
❑ Anxiety/Panic attack
❑ Syncope
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Remove patient from exposure/trigger
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Do all 3 simultaneously
❑ Call for help
❑ 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
Maximum dose 0.5 mg (adult) or 0.3 mg (child)
Record the time of the dose and repeat it in 5-10 minutes, if needed or
❑ In patients with hypotension/cardiorespiratory arrest and those not responding: Intravenous epinephrine
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)
Titrate based on clinical response or epinephrine side effects
❑ Place patient on back/comfortable position; elevate legs
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Give high flow supplemental oxygen (6-8 L/min) if:
❑ Respiratory distress
❑ Recieved repeated doses of epinephrine
❑ Asthma/other respiratory disease
❑ Co-existing cardiovascular disease
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Establish IV access
1-2 litres of 0.9% saline rapidly
 
 
 
 
 
 
 

References

  1. Sampson, HA.; Muñoz-Furlong, A.; Campbell, RL.; Adkinson, NF.; Bock, SA.; Branum, A.; Brown, SG.; Camargo, CA.; Cydulka, R. (2006). "Second symposium on the definition and management of anaphylaxis: summary report--Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network symposium". J Allergy Clin Immunol. 117 (2): 391–7. doi:10.1016/j.jaci.2005.12.1303. PMID 16461139. Unknown parameter |month= ignored (help)


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