Page 14 - Emergency medicine for students ebook

Anaphylaxis
Symptoms:
Ø Respiratory: Swelling of lips, tongue, pharynx and epiglottis, dyspnoea, wheeze, chest tightness, hypoxia, hypercapnia
Ø Skin: Pruritis, erythema, urticarial and angioedema
Ø CVS: Hypotension, shock, arrthymias, ischaemic chest
pain
Ø GI: nausea, vomiting, diarrhoea, abdo cramps Ø
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Pre hospital aid:
1. Call 999- note substance that induced reaction
2. Inject them with auto injector if they have one- eg Epipen:
Example of anaphylaxis in a paediatric patient https://firstaidforlife.org.uk/anaphylactic -shock-acute-allergic-reaction/
o hold pen in fist, pull of safety cap, inject orange end at 90 degrees at 10cm in outer mid thigh, hold for
10 seconds then remove, massage injection site for 10 seconds
o Each pen can only be used once
3. If no response- inject second Epipen after 5-15 mins
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Hospital treatment
1. Discontinue administration of suspected factor/remove sting by carefully scraping away from skin
2. Give 100% O2
3. Open and maintain airway- may require intubation or surgical airway
4. Drug administration:
Ø 0.5mg (0.5mL of 1:1000 solution) IM adrenaline
o if no improvement repeat in 5 mins
o If already been given Epipen the 300mcg dose usually
sufficient
o Give only 50% adrenaline dose to patients on tricyclic
antidepressants, MAOIs or beta blockers
Ø Beta 2 agonist nebulised with O2- eg 5mg salbutamol
Ø 1-2L IV 0.9% saline rapid infusion if hypotension doesn’t respond to
adrenaline
Ø Antihistamine: H1 blocker 10-30mg slow IV chlorphenamine and H2
blocker 50mg IV ranitidine
Ø 100-200mg slow IV Hydrocortisone
Ø Admit/observe after initial Treatment for 4-6hrs
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