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Emergency Response to Adult Anaphylaxis: Management of Allergic Reactions

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You arrive at the scene of a 50-year-old male experiencing difficulty breathing after a bee sting. He presents symptoms of shortness of breath, throat tightness, wheezing, and itching. This case illustrates the critical nature of allergic reactions and anaphylaxis, characterized by the release of histamine affecting the respiratory and cardiovascular systems. Assessment and emergency management, including the use of epinephrine, oxygen administration, and continuous monitoring, are essential for patient stabilization and care in cases of severe allergic responses.

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Emergency Response to Adult Anaphylaxis: Management of Allergic Reactions

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  1. Chapter 20 Allergies

  2. Case History You have arrived at the scene of an adult male having difficulty breathing. You find a 50-year-old male complaining of shortness of breath and tightness in his throat. He tells you that this began about 10 minutes ago after he was stung by a bee while mowing the lawn. You notice that he begins to wheeze as he tells you that his chest and hands feel itchy.

  3. Allergic Reactions and Anaphylaxis • Allergic reaction • Antibody-antigen reaction • Results in release of substances (e.g., histamine) • Affects the respiratory, circulatory, GI systems, and skin • Anaphylaxis • Antibody-antigen reaction gone haywire • Detrimental rather than protective

  4. Allergic Reaction • Possible causes • Insect bites/stings (bees, wasps, etc.) • Food (nuts, crustaceans, peanuts, etc.) • Plants • Medications • Others

  5. Assessment Findings • Skin • Warm, tingling feeling • Face, mouth, chest, feet, and hands • Itching • Hives

  6. Respiratory System • Tightness in throat/chest • Cough • Rapid breathing • Labored breathing • Retractions • Use of accessory muscles

  7. Respiratory System • Swelling of the airway • Noisy breathing • Inability to speak or cough • Hoarseness • Stridor • Wheezing (audible without stethoscope)

  8. Respiratory System • Respiratory failure • Respiratory arrest

  9. Cardiovascular System • Increased heart rate • Decreased blood pressure • Decreased perfusion (shock) due to vasodilation

  10. Generalized Findings • Itchy, watery eyes • Headache • Sense of impending doom • Runny nose

  11. Other Signs and Symptoms • Decreasing mental status • Signs of shock (hypoperfusion) • Respiratory distress

  12. Emergency Medical Care –Allergic Reaction • Initial assessment • Focused history and physical examination • Vital signs • Treatment

  13. Emergency Medical Care -Focused History/Physical Examination • History of allergies? • What was patient exposed to? • How was he or she exposed? • What effects? • Progression? • Interventions?

  14. Emergency Medical Care • Vital signs • SAMPLE history • Oxygen administration

  15. Emergency Medical Care • Patient has prescribed epinephrine? • Facilitate administration of preloaded epinephrine. • Reassess every 2 minutes. • Record reassessment findings. • No auto-injector • Transport

  16. Patient Without Respiratory Distress or Shock • Continue with focused assessment. • Patient should not receive epinephrine.

  17. Relationship to Airway Management • Airway/respiratory compromise may develop over time. • Ensure a patent airway. • Provide ventilation.

  18. Indications • Patient exhibits the assessment findings of an allergic reaction. • Medication is prescribed for this patient by a physician. • Medical direction authorizes use for this patient.

  19. Form of Medication and Contraindications • Medication form • Liquid • Automatic needle and syringe system • No contraindications, when used in a life-threatening situation

  20. Dosage • Adult: one adult auto-injector (0.3 mg) • Infant and child: one infant/child auto-injector (0.15 mg)

  21. Actions • Dilates bronchioles • Constricts blood vessels • Blocks histamine effects

  22. Increased heart rate Pallor Dizziness Chest pain Headache Nausea Vomiting Excitability, anxiety Side Effects

  23. Reassessment Strategies • Transport. • Continue focused assessment. • Airway • Breathing • Circulatory status

  24. Reassessment Strategies – Patient Condition Worsens • Signs/symptoms • Decreasing mental status • Increasing breathing difficulty • Decreasing blood pressure • Actions • Obtain medical direction. • Give additional dose of epinephrine. • Treat for shock (hypoperfusion). • Administer CPR and AED, as needed.

  25. Reassessment Strategies –Patient Condition Improves • Provide supportive care. • Oxygen • Treatment for shock (hypoperfusion)

  26. Summary • Management of severe allergic reactions requires • Rapid identification of signs and symptoms • Administration of epinephrine • Management of airway and ventilation • Key signs and symptoms • Hives, itching, coughing, sneezing, etc. • Signs of respiratory distress, airway obstruction, or shock

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