Anaphylaxis - Tuesday April 24, 2012

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.

You can read more about anaphylaxis here.