Anaphylaxis

Operating Department Skills

Anaphylaxis

Common causes...

Bee stings
Blood products
Contrast media
Dairy products
Drugs eg, Aspirin, Antibiotics, ACE inhibitors
Eggs
Latex
Shellfish
Tree nuts

Key indicators...

Sudden onset and progression of symptoms
Life threatening airway/breathing/circulation problems
Skin and mucosal changes: angioedema, flushing, urticaria

Symptoms...

Collapse
Abdominal pain
Nausea
Laryngeal oedema
Asthma
Difficult breathing/speaking/swallowing
Respiratory distress
Expiratory wheeze
Inspiratory stridor
Cardiovascular shock
Vasodilation
Hypotension
Tachycardia (> 100 bpm)
Angioedema
Capillary leakage
Hives (urticaria)
Itching
Pallor
Redness
Sweating

Note: In food allergies, swelling usually starts in the mouth and tongue, progressing to upper airway obstruction.

Assessment...

Airway: examine for oedema, stridor, wheezing
Breathing: measure respiratory rate
Circulation: pulse, BP, and capillary refill
Disability: response level (Alert, Voice, Pain, Unresponsive)
Exposure: assess body for urticaria and angioedema

Note: Be careful not to mistake a panic or vasovagal attack for anaphylaxis.

Treatment...

Recline patient flat
Raise patient's legs - if breathing unimpaired
Adrenaline*
High flow oxygen
IV crystalloids (adult:500 ml, child:20 ml/kg)
IV Chlorphenamine**
IV Hydrocortisone***

Adrenaline*

Intravenous:

Adult=50 micrograms; Child=10 microgram/kg

If IV access not available, use the IM route.

Intramuscular...

Age group	Dosage 1:1000
Adults	500 micrograms (0.5L)
Child, over 12 years	500 micrograms (0.5L)
Child, 6-12 years	300 micrograms (0.3L)
Child, under 6 years	150 micrograms (0.15L)

Chlorphenamine and Hydrocortisone*

(IM or slow IV)

Age group	Chlorphenamine	Hydrocortisone
Adult and child over 12 years	10 mg	200 mg
Child, over 6 - 12 years	5 mg	100 mg
Child, 6 months - 6 years	2.5 mg	50 mg
Child, under 6 months	250 micrograms/kg	25 mg

Resuscitation Council algorithm