Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Anaphylaxis Alex Pearce-Smith Scenario • A patient who is well but has been called in for a medication review has just sat down. Suddenly the practice nurse bursts in and announces that a patient to whom she has just vaccinated seems to be having a severe reaction. In Groups/Pairs Think About…. • What do you do initially? • What is your assessment? • What are the signs of anaphylaxis? Assessment • Excuse yourself from patient – go straight to sick patient and assess - ?help ABCDE. • Severe/Life threatening features in anaphylaxis. – – – – A Swelling, Hoarseness, Stridor. B RR, Wheeze, Sats <92%. C Pale, clammy, Low BP. D Confused/Drowsy/Coma. Recognising Anaphylaxis • Anaphylaxis likely when ALL 3 criteria met • 1. Sudden onset and rapidly progressing symptoms. 2. Life threatening Airway/Breathing/Circulatory problems. 3. Skin/Mucosal changes (angio-oedema, flushing or urticaria) PMH and circumstances may help (ie given vaccine). Skin Changes • Usually first feature but may be absent in upto 20% of • • • • • • cases. May be subtle or dramatic. May be just skin, just mucosal or both. Maybe patchy or generalised erythematous rash. May be urticaria – usually itchy. Angioedema is similar to urticaria but affects the deeper tissues – usually eyelids and lips but sometimes mouth and throat. Not an indicator of severity – most systemic skin reactions do not end up as anaphylaxis. Skin Presentations Differential Diagnoses • Vasovagal attack. • Panic attack. • Idiopathic urticaria. • Breath-holding episode in a child. Management • ABC assessment indicates severe/lifethreatening. – Lie flat, feet up*. – Remove trigger (e.g. bee sting). – IM adrenaline 0.5mg adult (over 12) less for children/babies. – Oxygen. – Fluid Challenge (crystalloid). – Chloramphenamine and hydrocortisone. – Some should be calling 999. Management • Should go to hospital for further management/observation – 6hrs minimum but most discharged by 24 hrs if good response. • Various indicators for longer observation. • Review by senior clinician before discharge. • Specialist follow up in allergy clinic. Common Triggers • Food (especially nuts) • Drugs – Antibiotics esp penicillin and cephalosporin – Anaesthetic drugs – Other drugs esp NSAIDs. • Venom – esp wasp stings. Mortality • Less than 1% mortality. • About 20 deaths per year in UK recorded due to • • anaphylaxis but may be underestimate. Asthmatics more at risk. Deaths happen quickly after contact with allergen. – Food 30 mins. – Venom 15 mins. – IV medications 5 mins. In conclusion • If severe or life-threatening symptoms and clinical suspicion of anaphylaxis – give adrenaline. • Remember ABC – you may not get beyond A. For More Information • For details about the recommended recognition and management of anaphylaxis including correct paediatric dosages etc go to Resuscitation Council Website. • http://www.resus.org.uk/pages/reaction.pdf