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Anaphylaxis: Rapid recognition and treatment. Miha Mežnar MD Medical intensive care unit General hospital Celje, Slovenia. Anaphylaxis: Rapid recognition and treatment. Fatal anaphylaxis. Pumphrey RSH, Clinical and experimental allergy, 2000. Anaphylaxis: Rapid recognition and treatment.

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anaphylaxis rapid recognition and treatment

Anaphylaxis: Rapid recognition and treatment

Miha Mežnar MD

Medical intensive care unit

General hospital Celje, Slovenia

fatal anaphylaxis
Fatal anaphylaxis

Pumphrey RSH, Clinical and experimental allergy, 2000

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

potentional pitfalls in recognition of anaphylaxis
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)
fatal anaphylaxis risk factors
Fatal anaphylaxis: risk factors
  • Concomitant asthma
  • No epinephrine
  • Non effective epinephrine
  • Upright posture
  • Other cardiopulmonary disease
fatal anaphylaxis risk factors1
Fatal anaphylaxis: risk factors
  • Concomitant asthma
  • No epinephrine
  • Non effective epinephrine
  • Upright posture
  • Other cardiopulmonary disease
fatal anaphylaxis1
Fatal anaphylaxis

Pumphrey RSH, Clinical and experimental allergy, 2000

adrenaline
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

treatment
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