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Anaphylaxis: Rapid recognition and treatment

Anaphylaxis: Rapid recognition and treatment

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Anaphylaxis: Rapid recognition and treatment

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  1. Anaphylaxis: Rapid recognition and treatment Miha Mežnar MD Medical intensive care unit General hospital Celje, Slovenia

  2. Anaphylaxis: Rapid recognition and treatment

  3. Fatal anaphylaxis Pumphrey RSH, Clinical and experimental allergy, 2000

  4. Anaphylaxis: Rapid recognition and treatment

  5. recognition • Underrecognized, undertreated • Most important dg marker is trigger • Over 40 symptoms and signs described

  6. Diagnostic criteria • Criterion 1: acute onset (minutes – hours) involving skin and/or mucosa + at least one: • Respiratory compromise • Reduced blood pressure • Criterion 2: At least 2 of the following, minutes – hours after exposure TO A LIKELY ALLERGEN FOR THAT PATIENT: • Skin/mucosal involvement • Respiratory compromise • Reduced blood pressure • Gastrointestinal symptoms • Criterion 3: Reduced blood pressure minutes – hours after exposure TO A KNOWN ALLERGEN FOR THAT PATIENT J Allergy Clin Immunol, 2006

  7. Potentional pitfalls in recognition of anaphylaxis • Absent / missed skin symptoms • Non-specific signs of hypotension (confusion, collapse, incontinence...) • Certain conditions (surgery) • DD – asthma exacerbation • Lab tets to support Dg (tryptase)

  8. Anaphylaxis: Rapid recognition and treatment

  9. Fatal anaphylaxis: risk factors • Concomitant asthma • No epinephrine • Non effective epinephrine • Upright posture • Other cardiopulmonary disease

  10. Fatal anaphylaxis: risk factors • Concomitant asthma • No epinephrine • Non effective epinephrine • Upright posture • Other cardiopulmonary disease

  11. Fatal anaphylaxis Pumphrey RSH, Clinical and experimental allergy, 2000

  12. Adrenaline • Review of literature: Database search Embase 223 Medline 92 Lilacs 13 Cochrane 10 CINAHL 5 BIOSIS 14 Web of science 25 Excluded: all 382 Included: 0 Sheikh A, Allergy 2009

  13. Treatment • Removal of the causing agent • Epinephrine • 0.3 – 0.5 mg (0.01mg/kg) i.m. (vastus lateralis), repeat 5 – 15 minutes • i.v. – titrate the dose • Oxygen • Intubate, if stridor or arrest • Trendelenburg position • i. v. Fluids (cristalloids vs. colloids?) • Steroides, antihistamines, inhaled beta agonists, glucagon of secondary (and questionable) importance