Resuscitation does not stop once the immediate threat is managed. Your team needs to plan ahead using a systematic approach to ensure your patient remains safe and the correct investigations are performed. It is common for a patient to require adrenaline therapy for many hours and ventilation may be impacted by the vast fluid shifts caused by histamine release. 💦✅
Here’s our Anaphylaxis Aftercare framework:
👉🏽 A: Airway and Arterial line
Once you have stabilised the patient, convert to an endotracheal tube and place an arterial line if you haven't already.
You'll need blood samples within the first hour to check mast cell tryptase levels. These tests are needed to effectively refer to the allergy clinic for skin testing.
Depending on the severity, a central venous line is often needed for ongoing administration of inotropes.
👉🏽 D: Destination & Discussions
The patient will usually be cared for in the intensive care unit. Depending on your centre, you may need to organise an ICU referral or arrange interhospital transfer. Open disclosure involving the patient (where possible) or the next of kin should occur as soon as possible.
Ref: Anaphylaxis summary document, Live Series 3. Author J Madden. Available at periopconcepts.com
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