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

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

EPINEPHRINE

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...

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 250-500 mg IV

Beta Agonists Corticosteroids

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 beta-blocker

inotropic, chronotropic, and vasoactive effects

causes endogenous catecholamine release

1 mg IV q5mins

Glucagon

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 self-injectable epinephrine. There should be proper educations regarding its use, technique, storage, and when to replace.