The management of anaphylaxis is epinephrine (adrenaline). Use the 1:1000 ampoule. All other therapies are purely secondary. Rapid diagnosis and treatment (adrenaline before or within 5 minutes of the onset of severe symptoms) improves efficacy of treatment and decreases the incidence of biphasic reactions.
- IMI adrenaline (epinephrine) 0.01 mg/kg of 1 mg / mL (1:1,000)
- max dose 0.3 mg IMI
- anterolateral thigh q 15 min PRN
- supine position
- nebulised salbutamol (for bronchospasm)
- H1 and H2 antihistamines IVI
- IVI hydrocortisone (or methylprednisolone)
- vasopressors, glucagon, IVF
In all but the mildest of cases (some say in all cases, regardless) monitor for 4-6 hours post treatment because:
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- biphasic reactions have been reported between 1-28 hours later
- greater caution if patient has reactive airways disease
Discharge instructions:
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- Rx. EpiPen (and how to use it)
- Medical Bracelet
- Allergist review for skin-prick testing to identify allergen/s
Observation at least 4 hours after treatment and symptom resolution. Admit if prior severe reaction, asthma (higher mortality), or inability to readily return for medical care.
Major causes include:
- medications
- foods (most common cause)
- insect stings
- anaesthetics
- latex
- exercise
- ~ 20% idiopathic
If the person goes into cardiopulmonary shock, essentially if profoundly hypotensive and unresponsive (or if cardiac arrest), then you may need to give intravenous 1:10,000 epinephrine.
