Anaphylaxis – ED

Anaphylaxis

1. In any patient presenting with shock, consider anaphylaxis as a possible diagnosis.

2. In a patient with symptoms and signs suggestive of anaphylaxis, recognize and make the diagnosis even when the presentation is incomplete (e.g., may exhibit only some of rash/hypotension/vomiting/wheezing/altered level of consciousness).

By definition, 2 systems: cutaneous (Rash, angioedema), GI (N/V/D), Resp (Wheeze), Cardio (HoTN) except anaphylactic shock (AMS) where often no skin response mounted.

3. Given a patient with a diagnosis of anaphylaxis, treat rapidly and aggressively by giving epinephrine appropriately and managing the airway early as required, and with timely IV access and appropriate fluid resuscitation.

When in doubt, give IM Epinephrine. It will clear the hives faster than benadryl.

1) Epinephrine (1:1000) 0.01mg/kg Q5min IM Q5min prn – no real max dose

  • consider IV Epinephrine (1:10000) after 4-5 IM Epi injections
2) Anti-H1: diphenhydramine 1mg/kg – max 50mg (po,iv,im)
3) Anti-H2: ranitidine 1mg/kg – max 50mg (IV or po)
4) Tx bronchospasm: Ventolin, atrovent; early intubation if concern of angioedema / Resp symptoms
5) Steroid: Methylpred or oral prednisone
6) Tx anaphylactic shock as septic shock: IVF + IV Epi drip
– Not in mild anaphylaxis

4. When discharging a patient after the resolution of an anaphylactic reaction, as part of the treatment plan prescribe appropriate emergency self-rescue medication (e.g., epinephrine), educate appropriately (MedicAlert, rebound symptoms, precipitant avoidance), and arrange follow-up (e.g., allergy testing/desensitization).

Disposition
1) usually observe 6hr – longer if sicker
2) Rx- EpiPen, train on how to use epi, refer to allergist for testing & Tx (desensitization)
3) medAlert bracelet, beware of Betablocker use (glucagon)
4) Avoid precipitant: food, venom, drugs (NSAIDs), EtOH, Exercise, Viral illness
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CCFP ExamApril 30th, 2015
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August 2020
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