NAP6 2018: Anaphylaxis

Number:

· Incidence: 1 in 10k but probably higher

· Mortality: 4%

Triggers:

· Antibiotics 47%

· Muscle relaxants 33%

· Chlorhex 9%

· Patent blue dye 5%

Presenting feature:

· Hypotension 46%

· Bronchospasm 18%

· Tachycardia 10%

· Hypoxaemia 5%

· Bradycardia 3%

· Absent capno 2%

Highest risk:

· Elderly

· Obese

Patient’s experience:

· We suck at communication

· Allergy testing takes ages (100 days)

· Very anxious next time

Our experience at presentation:

· Rash: not in everybody, not straight away

· Hypotension: everyone at some point

· Bronchospasm: esp if obese, asthmatic

· Cardiac arrest: is usually bradycardic PEA

· CPR: often delayed. If SBP <50 then jump on the chest

Our experience of the drugs:

· Onset is fast for NMBD

· Onset is slow for chlorhex and patent blue dye

· Sux tends to cause bronchospasm

· 90% of penicillin allergy is nothing of the sort

What to do: (with thanks to Dr. Adam Skinner)

· Recognise it: unexplained severe hypotension

· Oxygen + fluid + adrenaline

Feedback welcome at ketaminenightmares@gmail.com