So, your team suspects anaphylaxis. Without immediate treatment, your patient is in serious trouble. Thankfully, we have clear guidelines from ANZAAG about what to do. ✅😎
1️⃣ The first question to answer is: Is the systolic BP < 50mmHg?
If it is, then your team should head down the ALS pathway for non-shockable rhythm. Thankfully, the systolic is most likely going to be > 50mmHg, which means your team should grab the anaphylaxis box and start working through the acute management card.
Here is a brief outline of the guidelines:
👉🏼 DR: Remove triggers & stop procedure
Remove any likely triggers, inform the surgical team to stop the procedure if possible and prepare for a possible cardiac arrest. 🫀
👉🏼 S: Send for help & anaphylaxis box
At the very least, you should send for the anaphylaxis box, a senior anaesthetic nurse and another anaesthetist. In severe anaphylaxis or cardiac arrest, you will need plenty of hands… press the emergency bell! 🚨
👉🏼 AB: Secure airway, 100% O2
Although airway swelling is rare, you might need an endotracheal tube to overcome high airway resistance due to bronchospasm. Ensure the current airway is adequate and positioned correctly. Provide 100% oxygen and confirm tube position with end-tidal CO2.
👉🏼 C: IV Fluids (500-2000ml)
The initial bolus will depend on the severity, but will usually range from 500ml to 2000ml for the initial bolus. Make sure there are plenty of warmed fluid bags ready for the ongoing resuscitation. 💦
👉🏼 D: Adrenaline (boluses & infusion)
Some cases will respond to 20-50mcg (0.2-0.5ml of 1/10,000), others will require multiple, increasing doses (500mcg - 5mg) and some will progress rapidly to a cardiac arrest. Ultimately, you need to be ready with plenty of adrenaline!
Check out our Live Series session to see this in action!
Ref: https://anzaag.com/anaphylaxis-management/management-resources/
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