anaphylaxis management
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Transcript anaphylaxis management
ANAPHYLAXIS MANAGEMENT
3 RS FOR TREATING ANAPHYLAXIS
DON’T LOSE PRECIOUS TIME!!!
Early
recognition of an
anaphylactic reaction is
mandatory, since death
occurs within minutes to
hours after the first
symptoms.
AT THE EMERGENCY ROOM
POSITION
AIRWAY, BREATHING,
CIRCULATION
Assess airway patency because of the probability of
edema or bronchospasm
If there is severe laryngeal edema, intubation may
be difficult to do. Instead, ventilate the patient with a
bag-valve-mask
(cricothyrotomy is reserved when both intubation and
bag-valve-mask ventilation are not possible)
High flow oxygen. O2 saturation must be
maintained at above 90%
ESTABLISH IV ACCESS
For fluid therapy
isotonic crystalloid solutions (such as NSS or LRS)
to address the hypotension
Since there is hypotension and tachycardia, a fluid
bolus of 1L can be given. Further fluid therapy
depends on patient response
MONITORING
Cardiac monitoring: ECG
Blood Pressure monitoring
Pulse Oximetry: to monitor respiratory output and
gas exchange
MEDICATIONS
EPINEPHRINE
Drug of choice for life threatening reactions
Given in patients with systemic manifestations of
anaphylaxis
Can counteract the bronchospasm, hypotension,
and GI symptoms
EPINEPHRINE
Increases systemic vascular resistance
elevating diastolic pressure
Bronchodilation
increasing inotropy
Increasing chronotropy of the heart
reduces edema
EPINEPHRINE
Alpha Receptor
Reverses vasodilation by vasoconstriction
Reduces edema
Beta Receptor
Dilates broncial airways
On the heart: inc inotrophy and chronotropy
Suppress histamine and leukotriene release
Inhibit activation of mast cells
DOSAGE
Given IV (if not possible, IM on
anterolateral thigh)
B.
DIPHENHYDRAMINE (ANTIHISTAMINE)
against cutaneous effects of anaphylaxis
antagonize cardiac and respiratory effects
continued for 2-3 days after treatment of the acute
anaphylactic event.
Adult
25-50 mg IV/IM q4-6h
50 mg PO q4-6h
OTHER DRUGS...
Beta Agonists
Corticosteroids
May be given should
there be
bronchospasm
Continued because
patient has asthma
May be used to
decrease the incidence
or severity of delayed
reactions
Does not influence the
acute course of
disease
Methylprednisolone
125mg IV or
Hydrocortisone 250500 mg IV
Glucagon
used in addition to
epinephrine, not as a
substitute
May be given if
hypotension does not
resolve after
epinephrine and IV
fluids
Can be given in a
patient taking a betablocker
inotropic, chronotropic,
and vasoactive effects
causes endogenous
catecholamine release
1 mg IV q5mins
MANAGEMENT: FOLLOW UP
ALLERGEN AVOIDANCE
Avoid exposure to
inciting agent (such as
peanuts).
If peanuts were not
included in the
breakfast or the inciting
agent cannot be
identified, referral to an
allergologist.
Instruct the patient to return should there be
recurrent symptoms despite allergen avoidance and
antihistamine
EPI PEN
Patient may be allowed
to carry a selfinjectable epinephrine.
There should be proper
educations regarding
its use, technique,
storage, and when to
replace.