Download Anaesthetic Emergencies

Anaesthetic Emergencies
Acute Anaphylaxis
Dr T E Allan Palmer FRCA
FANZCA MD
[email protected]
Presentation
 Primary indicators
– Unexplained hypotension
– Bronchospasm
– Angioedema
 More likely to be anaphylaxis if:
– More than one feature
– Erythema, rash or urticaria
– Severe reaction
Immediate Management
 Remove trigger agent
– Stop injection or infusion of
drug
– Remove triggering materials
 Remember latex allergy
 Chlorhexidine
– Summon assistance
 Anaesthetist if in building, MET
otherwise
First Aid
 100% Oxygen
 Secure airway
– Beware LMA.
 Stomach inflation
 Subglottic Oedema
 Volume Expansion
– Fluid that doesn’t release histamine
– Hartmans initially
– 4% Albumen
Definitive Management CVS
 IV adrenaline
– 1:10,000 1ml increments. Typically 5+ml
 Need more if patient on beta blocker
 Repeat as needed
– Fast flowing IV
– Adrenaline infusion if reaction persists
 1mg adrenaline in 50ml 3-60mls per hour
 May need triple dose
 CPR as needed
Definitive Management RS
 Bronchospasm
– Systemic adrenaline first choice
– Nebulised salbutamol
– Steroids
 1gm (ie 10amps hydrocortisone)
 1gm methylprednisolone
Monitoring
 ECG in all cases
– Acute myocardial infarction common if history
IHD
 Blood pressure
– NIBP may read low due to low cardiac output
– Arterial line if in situ
 Hourly urine output
 CVP
Ongoing Management
 HDU or ICU monitoring
 Ongoing adrenaline if needed
 Supportive care
– Safe airway
– Oxygenation
– Cardiovascular support
Investigation
 Takes second place to treatment
 Mast Cell tryptase
– 1 to 4hrs after reaction and 6 weeks
later
– Cross match tube. Call lab as has to
be spun down and frozen
 History
– Detailed timeline of all events
 Subsequent skin testing
Think About!
 Chlorhexidine allergy
– Skin prep, shower soap, central lines lignocaine
gel!
 Latex allergy
– Particularly repeat exposures
Questions
 What is wrong with subcutaneous or IM
adrenaline?
 Why not use haemaccel if the blood
pressure is low?
 First monitor to show any changes?