xis for ILS Sept 10

8/3/2019 xis for ILS Sept 10

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Emergency Treatment ofAnaphylactic Reactions


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Objectives

To understand:

What is Anaphylaxis?

Who Gets Anaphylaxis? What Causes Anaphylaxis?

How to recognise anaphylaxis How to treat anaphylaxis


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What is Anaphylaxis?

Anaphylaxis is: A severe, life-threatening, generalised or

systemic hypersensitivity reaction.Anaphylaxis is characterised by: Rapidly developing, life threatening, Airway

and / or Breathing and or Circulationproblems

Usually with skin and / or mucosal changes


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Physiology

The body produces ImmunoglobulinE(1gE)

This causes histamine release Histamine triggers vaso-dilation, making

blood vessels more permeable

Producing shock symptoms and oedema In addition it can cause bronchospasm


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What causes anaphylaxis?

Stings Nuts Food Antibiotics Anaesthetic drugs Other drugs

Contrast Media


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Time to cardiac arrest

Adapted from PumphreyRS. Lessons for management of anaphylaxis from a study of fatal reactions.ClinExp Allergy2000;30(8):1144-50.


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Recognition and Treatment


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Recognition and Treatment

ABCDE approach

Treat life threatening problems Assess effects of treatment

Call for help early


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Airway problems

Airway swellinge.g. throat and tongue swelling Difficulty in breathing and swallowing

Sensation that throat is closing up Hoarse voice, dysphagia Stridor


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Breathing problems

Shortness of breath

Increased respiratory rate

Wheeze

Patient becoming tired

Confusion caused by hypoxia Cyanosis (appears blue) a late sign

Respiratory arrest


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Circulation problems

Signs of shock pale, clammy

Increased pulse rate (tachycardia)

Low blood pressure (hypotension)

Decreased conscious level

Myocardial ischaemia / angina Cardiac arrest

DO NOT STAND PATIENT UP


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Disability

Sense of impending doom

Anxiety, panic, confusion

Decreased conscious level caused

by airway, breathing or circulation

problem Abdominal Pain, Nausea & Vomiting


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Exposure look for skin changes

Skin changes often the first feature and arepresent in over 80% of anaphylactic reactions

Skin, mucosal, or both skin and mucosalchanges

Erythema a patchy, or generalised, red rash


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Exposure look for skin changes

Urticaria (also called hives, nettlerash, weals or welts) anywhere on

the body

Angiodema similar to urticaria but

involves swelling of deeper tissuese.g. eyelids and lips, sometimes inthe mouth and throat


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Treatmentof anaphylactic

reactions


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Anaphylactic reaction ?

Assess: Airway, Breathing, Circulation, Disability,Exposure

Diagnosis-look for:Acute onset of illness Life-threateningfeatures1

And usually skin changes

+/- Exposure to known allergen+/- Gastrointestinal symptoms

Call forhelp

Lie patient flat and raise legs (if breathing notimpaired)

Adrenaline

When skills and equipment available:

A.Establish airway

B.High flow oxygen Monitor:

C.IV fluidchallenge3 Pulse oximetry

Chlorphenamine4

ECGHydrocortisone5 Blood pressure


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Intra- muscular adrenaline

Adrenaline

IM doses of 1:1000 adrenaline (repeat after 5 min if no

better)

Adult or child more than 12 years: 500 micrograms IM (0.5mL)

Child 6 12 years: 300 micrograms IM (0.3mL)

Child 6 months 6 years: 150 micrograms IM (0.15mL)

Child less than 6 months: 150 micrograms IM (0.15mL)


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Fluids

500 1000 ml IV bolus in adults

20 ml/Kg IV bolus in child Monitor response give furtherbolus as necessary

Colloid or crystalloid (0.9% sodiumchloride or Hartmanns)

Avoid Colloid, if colloid thought tohave caused reaction

Once IV access established


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Cardiorespiratory arrest

Follow Basic and Advanced LifeSupport Guidelines

Consider reversible causes Give intravenous fluids

Need for prolonged resuscitation

Good quality CPR important


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Consider:

Complete Clinical Incident Form

Take blood for Mast Cell Tryptase

(gold tube) if possible 1-2 hours after

start of symptoms


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Anyquestions


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Summary

Anaphylactic reactions may occur suddenlyand become life threatening very quickly

When symptoms are recognized, helpshould be sought immediately

Give Adrenaline im. if there is any airwayinvolvement, signs of shock or loss ofconsciousness

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xis for ILS Sept 10