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Anaphylaxis & BLS in Schools

Anaphylaxis & BLS in Schools. Steve Rochester Resuscitation Council (UK) Instructor Resuscitation Officer Eastbourne DGH. Objectives. Understand the recognition & management of anaphylaxis Understand the aetiology of CP arrest Understand how to perform BLS. Anaphylaxis.

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Anaphylaxis & BLS in Schools

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  1. Anaphylaxis & BLS in Schools Steve Rochester Resuscitation Council (UK) Instructor Resuscitation Officer Eastbourne DGH

  2. Objectives • Understand the recognition & management of anaphylaxis • Understand the aetiology of CP arrest • Understand how to perform BLS

  3. Anaphylaxis ‘ a potentially life threatening allergic reaction, often explosive in onset, with symptoms ranging from mild flushing to upper respiratory obstruction’ • Anaphylaxis - IgE • Anaphylactoid - no IgE

  4. Causes of Anaphylaxis • Drugs • Insect Stings • Foodstuffs e.g. nuts / shellfish • Latex • IV Fluids / Blood products • Detergents / perfumes etc • Exercise induced (EIA)

  5. Nut Allergy • US Govt. Dept of Transportation • ‘Peanut Free’ zone • Passenger seat row; front & behind • Medical Documentation • 1986 Disabled access law • Times newspaper Sept 3 1998 p17 col 1

  6. Incidence • Difficult to predict / poor reporting • Cambridge A&E Dept 1in 1500 attendees ABC of Allergies 3rd Ed. Ch.16 p56 • USA 40 deaths due to Hymenoptera stings Allergy 2nd Ed. Ch. 11 p163 • 10-20 deaths per year in the UK A review of services for allergy; D.o.H. report July 2006

  7. Recognition • Skin rash / Itching • Facial Oedema • Bronchospasm • Hypotension • Vomiting • Abdominal Pain • Dysphonia • Dysphagia • Aura of impending doom

  8. Onset of Reaction ‘most life threatening reactions will occur within 30 seconds to a few minutes’

  9. Allergen • Route dependent: • Cutaneous • Ingestion • Respiratory • Circulatory • Idiopathic

  10. Initial Management • Remove / stop allergen • Oxygen therapy • Adrenaline 1:1000 IM: 0.5mg (0.5ml) >12yrs 250mcg (0.25ml) 6-12yrs 120mcg (0.12ml) 6m-6yrs 50mcg (0.05ml) <6months • Wheeze / Stridor • Hypotension • Significant Facial Oedema

  11. Epipen • Pre loaded & single use device • Remove grey cap • Push against thigh - autoinjector • Adult - 0.3mg of 1:1000 • Jnr - 0.15mg of 1:2000 • Hold in place for 10s • ALK-abello £28.19

  12. Anapen • Pre loaded / single use • Remove black needle cap & safety cap • Outer thigh, press red fire button • Hold in place for 10s • 0.3mg or 0.15mg • Celltech £30.67

  13. Secondary Management • Chlorphenamine: IM or slow IV / IO • 1-6yrs: 2.5 - 5mg • >6yrs: 5 - 10mg • >12yrs: 10 - 20mg • Hydrocortisone: 4mg/kg IV / IO • Prednisolone: 2mg/kg orally • Further adrenaline as indicated

  14. Long Term Management • Refer to an Allergy clinic • Avoidance of allergen (dietician advice) • Epipen / Anapen where appropriate • Medic Alert bracelet

  15. Summary • Many Causes • Remove Allergen • Call for Help • Oxygen • Adrenaline

  16. Aetiology of CP arrest • Respiratory problems • Bradycardia =Hypoxia • Prevention not cure • Outcome is poor

  17. National Audit of Paediatric Resuscitation • 1,127 events out of hospital: • 80% at home / 9% in a public place • 1% at school • 1% at recreational place (e.g. swimming pool) • 978 received CPR: • 62% - Asystole (12 survival to discharge) • 5% - VF (4 survival to discharge) • 6% - PEA (5 survival to discharge) • 2% - Bradycardia (7 survival to discharge)

  18. Risks to rescuer • Rescuer safety • Universal precautions • Equipment for ventilation

  19. Assessment • Safe approach • Stimulate & Shout • Unresponsive – call for help

  20. Airway

  21. Breathing • Look • Listen • Feel • 10 s: Normal Breathing -Yes or No?

  22. Normal Breathing - YES • Recovery position • A B C D • High flow oxygen • Blood glucose • Call for expert help

  23. Normal Breathing? - NO • Initially give 5 rescue breaths • 1-1.5 seconds inspiratory time

  24. Breathing - Equipment • Pocket mask – supplemental 02 • Bag / valve mask –high flow 02 • Suction!

  25. Circulation • Signs of Life: • Movement • Colour • Eye opening etc. • Pulse Checks • Adequate perfusion?

  26. Chest compressions

  27. Chest compressions

  28. Ratio • CPR ratio for all children: • 2 breaths 15 compressions – solo / 2 people • 2 breaths 30 compressions – lay rescuer • Rate 100bpm - Depth 1/3 of thorax • Effective CPR!

  29. Re-assessment & Help • 1 person – 1 minute CPR then call for help • 2 people – 1st person initiate CPR 2nd person call for help • Witnessed, sudden collapse & known cardiac disease call for help first then CPR.

  30. Foreign Body • Conscious effective cough • Conscious ineffective cough: • 5 back blows • 5 thrusts - chest for infant / abdo >1yr • Unconscious – open airway; 5 breaths; CPR

  31. Summary • Different aetiology than adults • Hypoxia • ABC • Effective CPR

  32. Any Questions • Email: steve.rochester@esht.nhs.co.uk • Direct line: 01323 414991

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