1. Resuscitation in special circumstances workshop Anaphylaxis
Version: Jun 2016

2. Learning outcomes At the end of this workshop you should be able to:
understand the approach to the patient with anaphylaxis
recognise the signs and symptoms of anaphylaxis
know how to manage the patient with anaphylaxis
understand the role of IM adrenaline
understand the potential complications of IV adrenaline and the indications for its use

3. Case study ABCDE What will you do now? A : clear
Clinical setting and history
A tourist has walked in to your hospital after having had a curry at a local restaurant. Despite asking for a meal with no nuts, he is sure that he could taste some in the curry. He gives a history of “nut allergy” and he feels a bit tight-chested.
Clinical course
ABCDE
A : clear
B : RR 18 min-1 SpO2 98% on room air, chest clear on ausculation
C : P 90 min-1, BP 110/60 mmHg
D : alert, anxious
E : normal
What will you do now? 3

4. Case study (continued)
Clinical course
Over the next 10 min, he becomes very short of breath, has widespread wheeze, develops an urticarial rash, and feels light headed.
ABCDE
A : complains of tightness in throat
B : RR 28 min-1, widespread wheeze
C : P 120 min-1, BP 80/60 mmHg
D : very anxious
E : widespread urticaria
What will you do now? 4

6. Drugs in Anaphylaxis Adrenaline IM vs IV IM dose and frequency
who can give IV and where?
Other medications
steroids
antihistamines
others

7. Drugs in Anaphylaxis Adrenaline IM in most environments
IV for experts in appropriate environments only
IM dose 0.5 mg every 5 minutes (rotate site)
autoinjector
Other medications
fluids
steroids
Antihistamines
(no role in anaphylaxis)
others
Once anaphylaxis diagnosed there is no value in antihistamine administration. Antihistamines have a role in allergy when response only itchy/rash. Antihistamines with sedation/hypotensive effects should be used on allergy response with caution.
Common reported indicators/precipitating events of death in anaphylaxis is failure to administer adrenaline (IM 0.5 mg) and moving/standing a patient up.

8. Any questions?

9. Advanced Life Support Course Slide set
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©Australian Resuscitation Council (June 2016)