Refractory Anaphylaxis

anaphylaxis anaphylaxis management anaphylaxis triggers patient safety refractory anaphyalxis May 13, 2024
Anaphylaxis will respond to standard management in 95% of cases. For the other 5%, your team needs a plan. The ANZAAG Anaphylaxis Management Guidelines have a card for this scenario. Here is an outline of what’s involved: πŸ‘‡πŸΌπŸ‘ŠπŸ˜Ž
 
1️⃣ Request more help
πŸ‘‰ Consider pressing the emergency bell or requesting experienced assistance
 
2️⃣ Triggers
πŸ‘‰ Check again if there are any possible triggers still being administered. These may include latex, chlorhexidine or synthetic colloids.
 
3️⃣ Monitoring
πŸ‘‰ Consider placing an arterial line
πŸ‘‰ Consider the use of echocardiography (TTE/TOE)
 
4️⃣ For resistant hypotension
πŸ‘‰ Additional 50ml/kg bolus of crystalloid
πŸ‘‰ Noradrenaline infusion
πŸ‘‰ Vasopressin bolus and infusion
πŸ‘‰ Glucagon bolus (for beta blocker reversal)
πŸ‘‰ Remember to ensure manual left uterine displacement in pregnant patients
 
5️⃣ For resistant bronchospasm
πŸ‘‰ Rule out oesophageal intubation, circuit malfunction, tension pneumothorax
πŸ‘‰ Continue adrenaline infusion
πŸ‘‰ Add bronchodilators
πŸ”Ί Salbutamol
πŸ”Ί Magnesium
πŸ”Ί Volatiles
πŸ”Ί Ketamine
 
6️⃣ Consider other diagnoses!
 
Build knowledge βœ…
Improve safety βœ…
 
Ref: https://anzaag.com/anaphylaxis-management/management-resources/

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