Anaphylaxis

Anaphylaxis
 Definition:
severe life threatening systemic hypersensitivity
 Recognition of anaphylaxis:
-Airway problems (swelling/hoarse voice/stridor )
-Breathing problems (dyspnea/ wheeze/resp. arrest)
-Circulation problems (pale/↑HR/↓BP/ECG changes/cardiac arrest)
-Skin & mucosal changes (the 1st feature & most common)
 Treatment of anaphylaxis :
- Patient positioning
-Remove the trigger if possible
-Drugs:
1. Adrenaline: (given IV/IM)…..see later
2. O2: (high flow )
3. Fluids:(500-1000 ml)may be repeated\IV or IO.
4. Antihistamines:(1-2amp.IMorIV)
5. Steroids:(1-5amp Hydrocortison IV)
6. Bronchodilators: ( IV aminophyline or Magnesium)
(Inhaled salbutamol, atrovent)
 Adrenaline :
The most important drug
Action: alpha receptor :V.C &↓edema
: ß receptor :B.D/↑myocardial
contractility/inhibits histamine
Dose : I.M dose >12 yrs 500 µg(0.5ml)
>6-12yrs 300 µg(0.3ml)
>6ms-6yrs 150 µg(0.15ml)
<6ms 150 µg(0.15ml)
I.V dose adult: 50 µg rptd on need
children: 1 µg/kg
 Side effects of IV adrenaline:
1. Life threatening hypertension
2. Tachycardia
3. Arrhythmias
4. Myocardial ischemia
so , always do monitoring using:
* Blood pressure
* ECG
* Pulse oximeteryc
If Cardiac arrest following anaphylaxis :
Start CPR . early ALS .prolonged CPR may be needed
early ETT, cricothyroidotomy
 Investigations:
 ECG,Chest X-ray,urea,ABG,electrolytes.
 Follow-up:
 Patient better to be under observation in hospital.
 On discharge
 Give clear instruction to return to hospital if symptoms return.
 Consider oral antihistaminic & steroids.