Anaphylaxis: Critical Treatment Pearls

Date: December 27, 2016Author: Owen Wood 0
Anaphylaxis is a life threatening condition, typically with extremely acute onset. Luckily, the treatment is simple… isn’t it? Here is a quick review to help you make the right decisions when treating this critical condition.
Since it is difficult to define anaphylaxis, we can sum it up as: A severe allergic reaction that will probably cause death if left untreated. The onset can take anywhere from minutes to hours, and the most common causes are:
Medications

Foods

Proteins (such as in blood product transfusions)

Animal and Insect Venom

Latex

Symptoms of anaphylaxis include but are not limited to:
Flushed skin

Puritis (itching)

Urticaria (hives)

Sneezing

Rhinorrhea (runny nose)

Nausea

Gastrointestinal problems

Dyspnea (shortness of breath)

Palpitations

Dizziness

Feeling of being choked by a Brazilian Jiu-Jitsu black belt.

Signs of anaphylaxis include but are not limited to:
Hypotension*

Tachycardia

Urticaria

Angioedema

Wheezing

Stridor

Cyanosis

Syncope

*Remember that hypotension in children is identified as a Systolic BP < (70 mmHg + (Age in years x 2))
Treatment:
If insults to the patients Airway, Breathing, or Circulation are identified intramuscular (IM) epinephrine must be given IMMEDIATELY! DO NOT DELAY THIS INTERVENTION! There are NO contraindications to IM epinephrine in the presence of a life threatening allergic reaction.

IV fluid bolus

Histamine 1 antagonist (i.e. diphenhydramine)

Histamine 2 antagonist (i.e. ranitidine)

Glucocorticoids* (i.e. methylprednisolone)

Nebulized Albuterol

*While corticosteroids like methylprednisolone are not particularly fast acting, they may help prevent or decrease the severity of a biphasic reaction, which is basically a re-occurrence of the allergic reaction after the patient has been removed from the source of the reaction, and the initial treatments have worn off.
Key Thoughts
IF THE PATIENTS AIRWAY, BREATHING, OR CIRCULATION ARE AT RISK OF COMPROMISE–GIVE IM EPINEPHRINE IMMEDIATELY!

Allergens can be airborn! Simply microwaving a bag of popcorn in the same room as a person who is allergic to corn may initiate a reaction.

Don’t forget about latex.

Epinephrine auto-injectors are not affordable for many patients, and they may not have one, even if they know they need one.

Patients who do have epinephrine auto-injectors may be too frightened to self-administer. Lay persons may also be uncomfortable doing this, or may improperly administer.

If a patient is taking beta-blockers, they may not respond appropriately to treatment with epinephrine. In this case, consider administration of glucagon 3.5-5 mg IV (similar to treatment of beta-blocker overdose).

Keep a close eye on the patients airway and be prepared to intubate or perform surgical cricothyrotomy.

Treat anaphylaxis aggressively!

 
Thanks for reading! If you haven’t done so already, please take a few moments to follow my blog via e-mail, Facebook, or Twitter. Please share this article with your friends and colleagues as well. As always be sure to follow your local protocols.
-Owen
 
References
Lin M. Paucis Verbis: Anaphylaxis. ALiEM. 2016 [accessed 2016 Dec 27]. https://www.aliem.com/2012/paucis-verbis-anaphylaxis/
Mustafa S. Anaphylaxis. Anaphylaxis: Practice Essentials, Background, Pathophysiology. [accessed 2016 Dec 27]. http://emedicine.medscape.com/article/135065-overview

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