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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.