MANAGEMENT OF

ANAPHYLAXIS
 Common clinical presentation
 Most of the time it is mild but can be LIFE THREATENING AND DEATH
 Symptoms include

 flushing
 itching
 facial swelling
 Urticaria
 abdominal pain
 diarrhea
 Wheeze
 stridor ANAPHYLAXIS
 shock
CAUSES
 Drugs – Penicillines, ARS, AVS
 Food- Peanuts
 Insects – Bees
 Other chemicals

FEATURES OF BAD PROGNOSIS

 Previous severe reaction
 History of increasingly severe reaction
 History of asthma
 History of being on Treatment with  - blockers
These patients may need admission to ward
for management ANAPHYLAXIS
   Symptoms Signs

Burning sensation in mouth, Itching of lips, Urticarial rash

  mouth, and throat. Feeling of warmth. Angio oedema
MILD Nausea Conjunctivitis

Abdominal pain
Bronchospasms
  Coughing/wheezing
Tachycardia
MODERATE Sweating
Pallor
Irritability

Severe bronchospasm
Difficulty breathing
Laryngeal oedema
  Collapse
Shock
SEVERE Uncontrolled defecation
Respiratory arrest
 
Cardiac arrest

ANAPHYLAXIS
MANAGEMENT
 Remove the allergen
 A, B, C Approach
 If total airway obstruction intubate or secure a surgical airway
 If airway obstruction with stridor get expert help
 Adrenaline 10g/kg IM
 Adrenaline 5ml 1:1000 nebulised
 Consider intubation or surgical airway
 If no problem assess breathing

 If no breathing give 5 rescue breaths and assess circulation

 If wheeze and no adrenaline given yet
 Adrenaline 10g/kg IM
 Salbutamol 5mg nebulised every 15 minutes
and follow asthma protocol ANAPHYLAXIS
 If no problem assess circulation
 If no pulse assess rhythm and commence appropriate arrest protocol

 If shocked
 Adrenaline 10g/kg IM – Repeat it every five (5) minutes if symptoms are
not reversed.
 Colloid 20ml/kg/ IV/IO – give repeated boluses.
 If more than 3 boluses needed the patient needs ventilator support in an
ICU care.
 If shock is resistant to IM adrenaline,  IV infusion of adrenaline
0.1- 5 micrograms per kg per minute
Additional inotropes are not necessary as adrenaline is a powerful
inotrope.

ANAPHYLAXIS
 It is customary to give hydrocortisone and Chlorpheniramine in anaphylaxis.
The benefit is doubtful
 Chlophenaramine
 Above 12 yrs 10-20 mg
 6-12 yrs 5-10 mg
 1-5yrs 2.5- 5 mg
 1month – 1 yr 250 micrograms/kg
 Not For neonates.

 Hydrocortisone – 4 mg/kg 4-6 hourly

 If no problem expose patient for secondary assessment.

ANAPHYLAXIS
 . Reassess ABC

 If there is airway deterioration still airway is and not secured

 Give further adrenaline 10g/kg IM
 Consider intubation or surgical airway

 If still wheezy and further parenteral adrenaline not given

 Give adrenaline 10g/kg IM
 Give hydrocortisone 4mg/kg IV
 Consider aminophylline 5mg/kg stat and 1mg /kg/min
 Salbutamol 4-6g/kg stat and 0.1-1g/kg/min

ANAPHYLAXIS
 After the management of shock,

 observed for organ damage

 Prevention of further episodes
 educating patient
 giving a diagnosis card
 are important aspects of patient management.

ANAPHYLAXIS