Ray and Billy presented a fascinating case of a woman with the flu who developed anaphylaxis in the ED.
- The diagnostic criteria for anaphylaxis, which Mike, our EM intern, pithily summarized as…
- If A, B, or C, give E (epinephrine)
- IM epinephrine is ALWAYS the treatment of choice for anaphylaxis, whether in the hospital or outside
- don’t forget to discharge with an epi auto-injector!
For those who want to know more:
- 1% of patients die/year of anaphylaxis, and do so quickly. This is thought largely 2/2 misdiagnosis and delays in care. So have a low threshold to treat!
- Enjoy this adorable pictogram of the diagnostic criteria (attached to the evernote)
Start with CAB (just like the new BLS)
- C – give IM epinephrine 0.3-0.5mg of 1mg/ml. This is lifesaving and emergent!
- aggressive IV fluid resuscitation + raise legs if tolerated
- A – evaluate airway for signs of airway edema and if present, intubate early vs surgical airway.
- With airway edema, call anesthesia or ENT emergently to intubate. Consider intubating in the OR if a surgical airway is being considered
- B – albuterol for bronchospasm and supplemental oxygen
- Adjunctive therapies
- Steroids: 125mg methylprednisolone IV q6h – controversial
- H1 – 50mg IV diphenhydramine
- H2 – 50mg IV ranitidine (use IV famotidine 40mg here)
- Identify and remove underlying cause
- Refractory symptoms
- Repeat epinephrine IM -> epinephrine gtt. Patients on beta blockers may not respond to epinephrine, in which case a glucagon infusion can be helpful.
- ALWAYS discharge with an epinephrine auto-injector
- refer to allergy/immunology for confirmatory testing
- update the allergy list in your EMR!
- Consider medic alert jewelry (or this pinterest page of medic alert tattoos)