Anaphylaxis

 

Recognise it:

Likely culprit

·     Relaxant

·     Antibiotic

·     Chlorhex

Likely features

·     A: swelling

·     B: bronchospasm

·     C: distributive shock

·     E: urticarial rash

Grading

1.    Mucocutaneous

2.    Multi-organ, non-life threatening

3.    Multi-organ, life threatening

4.    Arrest

 

Treat it:

Priorities

·     Oxygen

·     Fluid

·     Adrenaline

1.Call for help

·     Buzzer

·     Anaphylaxis box

2.Resuscitation

1.Oxygen:

·     Supplement

·     ±Intubate

2.Fluid:

·     CSL+++

3.Adrenaline:

·     IM adrenaline 500mcg vs infusion

·     Grade 2: IV 20mcg q1-2min

·     Grade 3: IV 100-200mcg q1-2min +

·     Grade 4: ALS probably

Other:

·     Stop the trigger, although it is really too late

·     Drugs: hydrocortisone, antihistamine

·     Access: A-line, CVC, IDC

·     Transfer to ICU

3.Cancel (probably)

Effects of anaphylaxis:

·     Fluid shifts

·     Vasoplegia

·     Coagulopathy

·     Organ failure

·     Impaired healing

(i.e. not back to normal once BP restored)

Other considerations:

·     Urgency of procedure?

·     Magnitude of procedure?

·     Severity of anaphylaxis?

4.Follow up

Testing:

·     Tryptase

o  1h, 4h, 24h

o  Significant rise = ↑20% + 2mcg/mL

o  i.e. reference range unhelpful

·     Skin prick testing

o  Delay 6/52

Referral:

·     Anesthetic allergy clinic referral

Documentation:

·     Document allergies in medical records

·     Alert document for patient to carry

 

 

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