Thank you to Dr. A. Page for hosting morning report and to team 5 for bringing a case from overnight.
We discussed the diagnosis and management of someone presenting with anaphylaxis. The diagnosis is made by meeting one of the following minutes to hours after exposure to a likely allergen:
- skin/mucosal manifestation + 1 of shock (decreased BP), or respiratory compromise.
- Two or more of: skin/mucosal manifestation, respiratory symptoms, hypotension, or GI symptoms.
- Hypotension after exposure of an exposure to a known allergen for that patient.
We discussed the management of anaphylaxis which include
- Securing airway
- Obtaining IV access
- Epinephrine injection (0.3 mg IM)
- IV fluid
- Benadryl (diphenhydramine) 50 mg (H1 blocker)
- Ranitidine 50 mg (H2 blocker)
- Methyprednisolone 125 mg IV
- Bronchodilators may be used
We also discussed that there can be a biphasic reaction hours after the initial episode.
We also discussed that for patients on beta-blocker, epinephrine may be ineffective, and that glucagon is needed.