2 min read - Anaphylaxis

A young man presented with a skin rash which he developed soon after eating a pizza. He had a generalized urticarial rash. He was not dyspnoeic. He came walking to the ward.

Image result for urticaria

House officer was noted that the blood pressure was 85/65mmHg. As the patient was asymptomatic he ordered one pint of IV normal saline over 30min. He also prescribed IV chlorpheniramine 10mg and IV hydrocortisone 100mg.

30 minutes later he was reviewed by the house officer. The patient was conscious and not dyspnoeic. But the blood pressure was 60/40mmHg.

He immediately called the SHO.

Diagnosis - Anaphylactic shock

Lesson

Anaphylaxis is a killer
Your patient will die in front of you unless you act fast
Once the anaphylaxis is established, it’s a nightmare to treat

There’s no other drug for anaphylaxis better and safer than ADRENALINE.

Never hesitate to give adrenaline if you suspect anaphylaxis.

Never hesitate to give adrenaline if you suspect anaphylaxis.

Never hesitate to give adrenaline if you suspect anaphylaxis.

You have to give adrenaline if the suspicion is high even if the patient is not meeting the diagnostic criteria for anaphylaxis.

Delayed administration of adrenaline is one of the main contributors for death in anaphylaxis.

Blood pressure may be normal very early due to compensation, but can crash within minutes.

Never falsely reassure yourself if the patient is asymptomatic with lowish blood pressure readings.

The dose is IM (Intramuscular) 0.5mg undiluted for adults.

It is injected into the mid outer aspect of the thigh. Don’t waste time trying to remove clothes.

Adrenaline can be repeated every 5-10 minutes depending on the response. If there’s inadequate response to the first dose get the seniors to come ASAP.

Never give adrenaline IV unless the patient is in a cardiac arrest.

Elevate foot end. If there’s no way to raise, raise both legs by yourself!

Get two large bore cannula in and give fast IV normal saline. Don’t be afraid to give fluids. Some patients require more than 5 liters. Yes, 5 liters.

IV chlopheniramine and IV hydrocortisone take time to act.

Anaphylaxis can have a biphasic course. Observe the patient for minimum of 24 hours.

Homework

What are the advices you will give to a patient who had anaphylaxis at the time of discharge.


Read the diagnostic criteria for anaphylaxis. 

Read about adrenaline autoinjectors. (Epipen)

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