Download anaphylaxis management

ANAPHYLAXIS MANAGEMENT
3 RS FOR TREATING ANAPHYLAXIS
DON’T LOSE PRECIOUS TIME!!!
Early
recognition of an
anaphylactic reaction is
mandatory, since death
occurs within minutes to
hours after the first
symptoms.
AT THE EMERGENCY ROOM
POSITION
AIRWAY, BREATHING,
CIRCULATION

Assess airway patency because of the probability of
edema or bronchospasm

If there is severe laryngeal edema, intubation may
be difficult to do. Instead, ventilate the patient with a
bag-valve-mask
(cricothyrotomy is reserved when both intubation and
bag-valve-mask ventilation are not possible)

High flow oxygen. O2 saturation must be
maintained at above 90%
ESTABLISH IV ACCESS

For fluid therapy

isotonic crystalloid solutions (such as NSS or LRS)
 to address the hypotension

Since there is hypotension and tachycardia, a fluid
bolus of 1L can be given. Further fluid therapy
depends on patient response
MONITORING

Cardiac monitoring: ECG

Blood Pressure monitoring

Pulse Oximetry: to monitor respiratory output and
gas exchange
MEDICATIONS
EPINEPHRINE

Drug of choice for life threatening reactions

Given in patients with systemic manifestations of
anaphylaxis

Can counteract the bronchospasm, hypotension,
and GI symptoms
EPINEPHRINE

Increases systemic vascular resistance

elevating diastolic pressure



Bronchodilation
increasing inotropy
Increasing chronotropy of the heart

reduces edema
EPINEPHRINE

Alpha Receptor
Reverses vasodilation by vasoconstriction
 Reduces edema


Beta Receptor
Dilates broncial airways
 On the heart: inc inotrophy and chronotropy
 Suppress histamine and leukotriene release
 Inhibit activation of mast cells

DOSAGE
Given IV (if not possible, IM on
anterolateral thigh)
B.
DIPHENHYDRAMINE (ANTIHISTAMINE)
against cutaneous effects of anaphylaxis
 antagonize cardiac and respiratory effects


continued for 2-3 days after treatment of the acute
anaphylactic event.
Adult
 25-50 mg IV/IM q4-6h
50 mg PO q4-6h
OTHER DRUGS...
Beta Agonists
Corticosteroids
May be given should
there be
bronchospasm
 Continued because
patient has asthma


May be used to
decrease the incidence
or severity of delayed
reactions
 Does not influence the
acute course of
disease
 Methylprednisolone
125mg IV or
Hydrocortisone 250500 mg IV
Glucagon
used in addition to
epinephrine, not as a
substitute
 May be given if
hypotension does not
resolve after
epinephrine and IV
fluids
 Can be given in a
patient taking a betablocker

inotropic, chronotropic,
and vasoactive effects
 causes endogenous
catecholamine release
 1 mg IV q5mins

MANAGEMENT: FOLLOW UP
ALLERGEN AVOIDANCE

Avoid exposure to
inciting agent (such as
peanuts).

If peanuts were not
included in the
breakfast or the inciting
agent cannot be
identified, referral to an
allergologist.

Instruct the patient to return should there be
recurrent symptoms despite allergen avoidance and
antihistamine
EPI PEN

Patient may be allowed
to carry a selfinjectable epinephrine.
There should be proper
educations regarding
its use, technique,
storage, and when to
replace.