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Airway and Epi! Airway and Epi! Airway and Epi!

Introduction

  • Anaphylaxis is caused by massive uncontrolled release of chemicals after exposure to “antigen”
  • The antigen causes extensive mast cell and basophil cross-linking/activation
  • Common antigens
    • Foods
    • Drugs
    • Insect venoms

Basic Approach

  • Step 1: Diagnose anaphylaxis
    • Consider anaphylaxis if the patient has TWO body systems involved
    • Dermatologic symptoms
      • Flushing
      • Rash
      • Urticaria
    • Pulmonary symptoms
      • Shortness of breath
      • Wheezing
    • Cardiovascular symptoms
      • Hypotension
      • Lightheadedness
    • Gastrointestinal symptoms
      • Nausea/Vomiting
      • Diarrhea
  • Step 2: Give epinepherine
    • A major pitfall in the treatment of anaphylaxis is delay of epinephrine!!!
    • Normal adult “EpiPen” contains 0.3mg epinephrine
    • Normal dosing of IM epinephrine is 0.01mg/kg
  • Step 3: Consider intubation
    • The second biggest pitfall in the treatment of anaphylaxis is delaying intubation until it’s extremely difficult to intubate!!!
  • Step 4: Give adjunct medications
    • H1 blocker
      • Diphenhydramine
    • H2 blocker
      • Ranitidine
    • Steroids
      • Prednisone, dexamethasone, etc
  • Step 5: Send the patient home with an EpiPen prescription
    • Education them on this
    • Articulate this part of the plan to your attending
  • Bonus
    • Refractory anaphylaxis
    • Beta-blockers?
      • Treat with glucagon

Additional Reading