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Anaphylaxis

Anaphylaxis. Lucy Walker 27 th February 2013. Curriculum Requirements. 2.14 Management of Emergencies in Palliative Medicine: “To have the knowledge, understanding and skills to manage emergencies in Palliative Medicine”: Management of Anaphylaxis. Aims.

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Anaphylaxis

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  1. Anaphylaxis Lucy Walker 27th February 2013

  2. Curriculum Requirements • 2.14 Management of Emergencies in Palliative Medicine: “To have the knowledge, understanding and skills to manage emergencies in Palliative Medicine”: • Management of Anaphylaxis

  3. Aims • To provide an overview of the investigation and management of anaphylaxis; • To revise the Resus Council algorithm; • To highlight the key recommendations in the NICE guidelines

  4. Learning Objectives • By the end of the session, you will be able to: • identify a patient with anaphylaxis • confidently list the drugs and doses involved in the management of anaphylaxis • send Mast Cell Tryptase tests

  5. True or False: PART ONE • The UK incidence of anaphylactic reactions is increasing • Patients with asthma are at a higher risk of anaphylaxis • Adrenaline should be given with a green needle • There is a 5% fatality rate from anaphylaxis • Adrenaline should be given at half the recommended dose in patients who are taking Tricyclics • Nuts are the commonest cause of fatal anaphylaxis in the UK • Skin or mucosal changes alone can indicate anaphylaxis • All fatal cases of anaphylaxis should be discussed with the coroner • Patients should be monitored for at least 24 hours after anaphylaxis • It is important to find and remove the stinger is a suspected anaphylaxis due to insect sting

  6. Definitions • “Anaphylaxis is a severe, life-threatening, generalised or systemic hypersensitivity reaction” • Immunologically (IgE) mediated/ allergic • Non-immunologically mediated • Idiopathic

  7. Recognition

  8. The Algorithm Game

  9. Mast Cell Tryptase • Tryptase is a major protein component of mast cell secretory granules; • Useful in follow up of suspected anaphylaxis rather than initial diagnosis; • Must record time of onset of symptoms; • Minimum- one sample 1-2 hours post onset • Ideally- three samples (as soon as resus starts, 1-2 hrs after symptom onset, at 24 hours/ in allergy follow up clinic)

  10. Monitoring Period • Beware of the Biphasic reaction • Observe for at least 6 hours in a place with facilities to deal with life threatening ABC problems. • Further medical review prior to discharge. • Keep high risk patients for up to 24 hours • Consider 3 days of steroid and anti-histamine

  11. Follow Up • All patients presenting with anaphylaxis should be referred to an allergy clinic • Patient Education • Offer an adrenaline auto-injector (and advice about how and when to use it) • ?Anaphylactic reactions to drugs should be reported with a yellow card.

  12. True or False: • A chance to change…

  13. True or False: PART TWO • TRUE: • The UK incidence of anaphylactic reactions is increasing • Patients with asthma are at a higher risk of anaphylaxis • All fatal cases of anaphylaxis should be discussed with the coroner • It is important to find and remove the stinger is a suspected anaphylaxis due to insect sting

  14. True or False: PART TWO • FALSE: • Adrenaline should be given with a green needle • There is a 5% fatality rate from anaphylaxis • Adrenaline should be given at half the recommended dose in patients who are taking Tricyclics • Nuts are the commonest cause of fatal anaphylaxis in the UK • Skin or mucosal changes alone can indicate anaphylaxis • Patients should be monitored for at least 24 hours after anaphylaxis

  15. Take Home Messages • Ensure an A, B or C problem in addition to any skin or mucosal changes to make diagnosis • Safest to treat if these criteria are fullfilled • Adrenaline (1 in 1000) 500 micrograms IM and repeat at 5 minute intervals if needed • Remember Mast Cell Tryptase and specialist referral in appropriate patients

  16. References • Resuscitation Council UK (2008) Emergency treatment of anaphylactic reactions (www.resus.org.uk). London: Resuscitation Council (UK) • National Institute for Health and Clinical Excellence (2011) Anaphylaxis: assessment to confirm an anaphylactic episode and the decision to refer after emergency treatment for a suspected anaphylactic episode [CG134]. London: National Institute for Health and Clinical Excellence

  17. Any Questions??

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