National institute of allergy and infectious diseasesassociated symptoms of organ dysfunction – hypotonia , syncope , incontinence
Food commonest,1/3,peanuts and crustaceans commonest,wasp and bee stings ,antibiotics first,pencillin,next goes to rcm,1/3 unidentified.
Mild to fatal
Alpha 1 and beta 2 agonistic action,alpha action increases pvr and reverse peripheral vasodialation,vascularpermeability,and systemic hypotension.b agonist effect produces bronchodialation,cause positive ionotropic and chromotropic cardiac activity,and result in increased production of camp.epinephrine therefore reverses bronchospasm,stimulates increased cardiac output,and inhibits further mediator releaseExcessive alpha agonist activity can result in hypertensive crisis excessive b agonist activity can result in increse myocardial oxygen consumption,through increased wall tension,contractility and chronotropism and can produce hemodynamically significant supraventricular and ventricular dysrhytmias.
1 ml of in 1;1000 in 500 ml of d5w oor ns and running at a rate of 1-4 mic/min(0.5 -2ml/min)
Usually single dose will be sufficient
As early as possible,no gastric lavage
To prevenr biphasic reaction and recurrences,prednisolone for 7-10 days,onset of action 4-6 hrs
Diphenhydramine 25-50 mg,cpm 10 -20 mg,blocks action of circulating histamine on target tissue,h2 blockers effectson effect of histamine on myocardial and peripheral vascular tissue.
Mgso4 1-2 gnm iv over 30 mins
Causes positive ionotropism by augmenting camp synthesis through a noradrenergic pathway
AGAINST PROTECTION ANA - Against PHYLAX - Guard Pharoh Menes - 2641 BC
DEFNITION Serious allergic reaction that is rapid in onset and may causedeath. Multi organ involvement Precipitated with in minutes of exposure to a particular allergen In a sensitized patient
Clinical criteria for Anaphylaxis1.Acute onset of illness with involvement of skin and/ormucosal tissue along withResp.compromise / hypotension / associated symptomsof organ dysfunction2.Rapid onset of 2 0r more of the following after exposure tolikely allergen:Involvement of skin and/or mucosal tissueResp.compromiseHypotensionG I symptoms3. Known allergen with hypotension
FIRST LINE THERAPY Airway Breathing Circulation IV O2 monitor
FIRST LINE THERAPY EPINEPHRINE Drug of choice IV/IM
EPINEPHRINE IV Severe upper airway obstruction Acute respiratory failure Shock Caution but not contra indicated..
EPINEPHRINE Dose 100 microgram (0.1 mg) bolus over 5 to 10 mins 0.1 ml of 1:1000 diluted in 10 ml NS Start infusion if there is no response (1-4 mic/min) 0.1 mic/kg/min in children Stop if chest pain or arrhythmia occurs
EPINEPHRINE IM LESS SEVERE SYMPTOMS Dose: 0.3 -0.5 ml of 1:1000 May be repeated every 5 to 10 mins Antero lateral thigh is preferred over deltoid
SECOND LINE THERAPYAEROSOLISED BETA AGONISTS Salbutamol Levosalbutamol Ipratropium bromide Severe persistent cases magnesium may be used
SECOND LINE AGENTSGLUCAGON Reserved for patients on beta blockers and refractory to initialmeasures 1 mg IV every 5 minutes until hypotension resolves followed by5 – 15 mics / min infusion. Side effects: Hypokalemia , hyperglycemia , nausea , vomiting.
PREVENTION Allergy history Label all loaded syringes Give drugs in distal extremity whenever possible Ensure all patients wait in ED for atleast 30 mins after any drugadministration
PREVENTION Warning identification Avoid any known allergens Epipen Use allergy bands for all predisposed patients.
TAKE HOME Always ABC first Epinephrine is the drug of choice Anaphylaxis is very near to severe allergic reactions Change beta blockers Put on long term steroids if it is idiopathic anaphylaxis Educate every patient about prevention