ANAPHYLAXIS

Prepared by:

South West Education Committee

South West Education Committee

Anaphylaxis Protocol

SWEC MEMBERS

Cambridge – Lori Smith Grey Bruce – Andy Whittemore Hamilton – Ken Stuebing, Tim Dodd Lambton – Judy Potter London – Tre Rodriguez Niagara – Greg Soto Windsor – Cathie Hedges RTN – Peter Deryk

“The Power of 7” Base Hospital Programs

Goal: One single certification for all of SouthWestern Ontario by Fall 2005!!

Recert process same across SW this year. Notice, all paperwork will say SWEC. Some information may not be specific to

Hamilton BH or Services in our area. Pictures for data base in one of the stations

OBJECTIVES

Review basic pathophysiology of Anaphylaxis

Review Anaphylaxis. At the end of this session you should be

able to describe and explain: Anaphylaxis and its’ treatment protocols.

ANAPHYLAXIS

An immediate, systemic, life-threatening allergic reaction associated with major changes in the cardiovascular, respiratory and cutaneous systems.– Prompt recognition and appropriate drug

therapy are important to patient survival.

Pathophysiologyof anapnylactic shock.PATHOPHYSIOLOGY

A, B, C, … Assess the patient’s… Airway (do they have

one? Can they maintain it?

Breathing (are they) Circulation (pulses) ECG (Is the monitor

on?)

ASSESSMENT

What is the patients chief complaint?

Possible anaphylaxis?

If “NO” then assess treat & transport.

If ‘YES” get a Hx.

REVIEW

Chief Complaint– One or more symptoms for which the patient

is seeking medical care– Most chief complaints are characterized by:

• Pain• Abnormal function• A change in the patient's normal state• An unusual observation made by the patient (e.g.,

heart palpitations)

REVIEW

Chief Complaint– Be alert to the possibility that a chief

complaint may be misleading or that a problem may be more serious than the patient's chief complaint

The patient – May not be exactly sure what is bothering

him/her

ANAPHYLAXIS

If you suspect anaphylaxis then:

Get a history of present illness (HPI).

Be thorough, yet time efficient.

REVIEW

History of Present Illness (HPI)– Identifies the chief complaint and provides

a full, clear, chronological account of the symptoms

– A thorough HPI requires skill in:• Asking appropriate questions related to

the chief complaint• Interpreting the patient's response to

those questions

ANAPHYLAXIS

Assess/obtain the patients vitals.– Level of

Consciousness– Blood Pressure– Pulse/ECG– Respiratory rate– Capillary refill– SpO2 reading– Skin

ALLERGIES

Did you ask about allergies?

Did you look for a medical alert tag?

If unconscious, check for a medic alert tag.

ANAPHYLAXIS – S&S Wheezing Stridor Hypotension (systolic less than 90) Decreased LOC Airway compromise Edema Urticaria ( with at least one of the above)

ANAPHYLAXIS ?

Does your exam identify:

Generalized urticaria?

Generalized or local edema?

Urticariaas a result of an allergic reaction.What does Urticaria look like?

TUNNEL VISION Generalized urticaria!!! How is the patients airway?

ANAPHYLAXIS - SOB

On exam do you note/observe any of the following?

Wheezing? Stridor? Shortness of

breath?

ANAPHYLAXIS - SOB

If yes, then begin treatment.

Remember urticaria must be accompanied with wheezing and/or stridor, etc.

ANAPHYLAXIS - TREATMENT

Oxygen–NRB @ 15 L/min.

Epinephrine 1:1000 If 30 kg give

0.3 mg If 30 kg give

0.1 mg/10 kg rounding to nearest 0.05 mg.

WHY EPINEPHRINE?

Increases vascular smooth muscle tone (alpha agonist).

Decreases tone in alveolar smooth muscle (beta agonist).

ANAPHYLAXIS TREATMENT

Reassess patient Be prepared to

control their airway.

BVM Suction

ANAPHYLAXIS TREATMENT

Repeat Epi x 1 if: Condition does

not improve after 10 minutes.

Patient deteriorates.

ANAPHYLAXIS TREATMENT

Remember OMITR

Oxygen Monitor Intervention(s) Transport ASAP Reassess often

SUMMARY

If patient has self-administered, follow the rules for a second administration

Following 1st Epi. If wheezing develops or is present consider the SOB protocol.

Urticaria alone is not an indicator for Epi.!

QUESTIONS?