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