Anaphylaxis

 

Recognise it:

Likely culprit

·      Relaxant

·      Antibiotic

·      Chlorhex

Circulation problem

·      Distribute shock

·      Urticarial rash

Breathing problem

·      Bronchospasm

·      Upper airway swelling

·      (these are rarely the life-threatening problem)

 

First:

Priorities

·      Oxygenation

·      Circulation

Call for help

·      Press buzzer

·      Get anaphylaxis box

Resuscitate

 

-          If arrested

·      CPR

·      IV adrenaline 1mg q2min

·      Crystalloid

·      Intubate

-          If peri-arrest

·      IV adrenaline 50mcg q1min

·      Crystalloid 1L

·      Intubate

 

Second:

Treatment

·      Adrenaline infusion: 3mg in 50mL -> mL/h = mcg/min

·      Glucocorticoid: hydrocortisone 2mg/kg

·      Antihistamine: e.g. promethazine

Monitoring

·      Art line

Access

·      CVC

Testing

·      Tryptase <1h, 4h, 24h

 

Third:

Surgery

·      If grade 1 and urgent -> cancel

·      If grade 4 and non-urgent -> cancel

·      If in between -> discuss with team

o    Err on side of cancellation

o    Risk of relapse

o    Increased risk of surgical complications

Disposition

·      HDU