Nabila Nurul Hasanah |Anaphylactic Shock 071201 10095 Management eg, throat & Wheeze pale, clammy perfusion anaphylactic Difficulty in Cyanosis decreased consciousness: ‘mucosal, or both breathing & Fiespiratory arest consclous level or ea ore + Stridor myocardial + urticaria ischemia& ECG changes Cardiac arrest + angioedema + possible/known allergen + Acute onset of a reation (minutes-hours) with involvement of the skin, mucosal tissue, or both (Le. generalised hives, pruritus, or fushing, swollen ips-tongue-uvula) & atleast 1 ofthe following: + respiratory compromise: + reduced BP or symptoms of end-organ-dystunction + 2or>of the following that occur rapidly (minutes or hours) after exposure toa likely allergen for that patient * involvement ofthe skin/ mucosal tissue or both (Le., generalised hives, pruritus, or fushing, swollen lips-tongue- uvula), + respiratory compromise(ie., dyspnoea, wheeze-bronchospasm, stridor, reduced PEF, hypoxaemia), + reduced BP or associated symptoms of end-organ dysfunction (Le., hypotonia/ collapse, syncope, incontinence) + persistent GI symptoms(i.e.,crampy abdominal pain, vomiting) ‘+ Reduced BP after exposure to a known allergen (minutes-several hours) + adult: systol BP of <30mmHg or >30% decrease form baseline: infants & children: low systol BP 07230% in ¥ + 1 Life-threatening problem: ‘+ 31V fluid challenge: wide-bore(14-16) 1. Airway: swelling, hoarseess, + Aduit't-2 L 0.9% isotonic saline 5- stridor ‘1omikg in 5-10 minutes 2. Breathing: rapid breathing, + Child: 10 muikg wheaze, fatigue, cyanosis, SpO2 + Stop IV colloid ifthis mightbe the cause of -<92%, contusion anaphylaxis 3. Circulation: pale, clammy, low BP, ‘+ 4 Chlorphenamine (IM or slow IV) + Aduitor child >12 years: 10 mg + Child 6-12 years:5 mg + Child 6 months-6 years: 2.5 ma ‘+ 2 Adrenaline (give IM unless experienced with IV adrenaline) ‘+ IMdoses of 1:1000 adrenaline (repeat ater 5 min itno better) + Child <6 months: 250 + Adult: 0.01 mg/kg; max 500 Establish airway micrograms M (0.5 mL) + High flow oxygen + 5 Hydrocortisone (IM or slow IV) '* Child >12 years: 500 micrograms ‘+ IV fluid challenge (3) in] ‘+ Adult or child >12 years: 200 mg IM (05 mL) 15 minutos + Child 6-12 years: 100 mg ‘+ Child 6-112 years:300 micrograms ‘+ Chlorphenamine (4) + Child 6 months-6 years: 50 mg IM (0.3 mL) + Hydrocortisone (5) + Child <6 months: 25 + Child <6 years: 150 micrograms + Monitor: rmicroarams/ka 1M (0.15 mL) * Pulse oximetry ‘+ Adrenaline IV to be given only by + ECG: tryptase experienced specialists (onan + Repeat Adrenaline § minutes ater itno + Tivato: Adults 50 micrograms; Childron 4 be rove ang rmicrogramikg + Perform GPR when indicated anytime + ICU ithypotension persisted + Discharge alter stabilized + Continue oral chiorphenamine itching + educate: SAFE (seek suppor, allergen, follow up:there mightbe 2nd] _ continues ‘atiack-biphasic anaphylaxis, epinephrine) + Give nebulized salbutamol it wheezing prosont 2