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Anaesthetic Emergencies

Anaesthetic Emergencies. Acute Anaphylaxis Dr T E Allan Palmer FRCA FANZCA MD allan@palmer.net.au. Presentation. Primary indicators Unexplained hypotension Bronchospasm Angioedema More likely to be anaphylaxis if: More than one feature Erythema, rash or urticaria Severe reaction.

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Anaesthetic Emergencies

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  1. Anaesthetic Emergencies Acute AnaphylaxisDr T E Allan Palmer FRCA FANZCA MDallan@palmer.net.au

  2. Presentation • Primary indicators • Unexplained hypotension • Bronchospasm • Angioedema • More likely to be anaphylaxis if: • More than one feature • Erythema, rash or urticaria • Severe reaction

  3. Immediate Management • Remove trigger agent • Stop injection or infusion of drug • Remove triggering materials • Remember latex allergy • Chlorhexidine • Summon assistance • Anaesthetist if in building, MET otherwise

  4. First Aid • 100% Oxygen • Secure airway • Beware LMA. • Stomach inflation • Subglottic Oedema • Volume Expansion • Fluid that doesn’t release histamine • Hartmans initially • 4% Albumen

  5. Definitive Management CVS • IV adrenaline • 1:10,000 1ml increments. Typically 5+ml • Need more if patient on beta blocker • Repeat as needed • Fast flowing IV • Adrenaline infusion if reaction persists • 1mg adrenaline in 50ml 3-60mls per hour • May need triple dose • CPR as needed

  6. Definitive Management RS • Bronchospasm • Systemic adrenaline first choice • Nebulised salbutamol • Steroids • 1gm (ie 10amps hydrocortisone) • 1gm methylprednisolone

  7. Monitoring • ECG in all cases • Acute myocardial infarction common if history IHD • Blood pressure • NIBP may read low due to low cardiac output • Arterial line if in situ • Hourly urine output • CVP

  8. Ongoing Management • HDU or ICU monitoring • Ongoing adrenaline if needed • Supportive care • Safe airway • Oxygenation • Cardiovascular support

  9. Investigation • Takes second place to treatment • Mast Cell tryptase • 1 to 4hrs after reaction and 6 weeks later • Cross match tube. Call lab as has to be spun down and frozen • History • Detailed timeline of all events • Subsequent skin testing

  10. Think About! • Chlorhexidine allergy • Skin prep, shower soap, central lines lignocaine gel! • Latex allergy • Particularly repeat exposures

  11. Questions • What is wrong with subcutaneous or IM adrenaline? • Why not use haemaccel if the blood pressure is low? • First monitor to show any changes?

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