This document provides guidelines for emergency management of anaphylaxis in adults and children. It recommends early treatment with adrenaline/epinephrine injection, oxygen, IV fluids, adjunctive treatments like H1 antihistamines, H2 receptor antagonists, nebulized bronchodilators, glucagon or corticosteroids if needed. It emphasizes initiating treatment as soon as signs of respiratory difficulty, shock or hypotension are present.
This document provides guidelines for emergency management of anaphylaxis in adults and children. It recommends early treatment with adrenaline/epinephrine injection, oxygen, IV fluids, adjunctive treatments like H1 antihistamines, H2 receptor antagonists, nebulized bronchodilators, glucagon or corticosteroids if needed. It emphasizes initiating treatment as soon as signs of respiratory difficulty, shock or hypotension are present.
This document provides guidelines for emergency management of anaphylaxis in adults and children. It recommends early treatment with adrenaline/epinephrine injection, oxygen, IV fluids, adjunctive treatments like H1 antihistamines, H2 receptor antagonists, nebulized bronchodilators, glucagon or corticosteroids if needed. It emphasizes initiating treatment as soon as signs of respiratory difficulty, shock or hypotension are present.
This document provides guidelines for emergency management of anaphylaxis in adults and children. It recommends early treatment with adrenaline/epinephrine injection, oxygen, IV fluids, adjunctive treatments like H1 antihistamines, H2 receptor antagonists, nebulized bronchodilators, glucagon or corticosteroids if needed. It emphasizes initiating treatment as soon as signs of respiratory difficulty, shock or hypotension are present.
2015/16 ACUTE RESPIRATORY DIFFICULTY (Progressive Swelling, Stridor, Wheezing, Distress) and/or SIGNS OF SHOCK/HYPOTENSION (especially if skin or mucosal changes are present)
Early (first line) treatment
ADRENALINE 1mg/ml (1:1000) - 0.01mg/kg IM (Maximum - 0,5ml IM) or Auto-Injector > 6 yrs - 0,3 ml IM < 6 yrs - 0,15 ml IM Repeat every 5 - 15 minutes if no improvement
OXYGEN – MONITORS – IV ACCESS
• High flow oxygen • Maintain patent airway (Intubate/Cricothyrotomy if necessary) • BP, Sats, ECG monitoring • Lie patient supine with legs elevated if hypotensive • High flow IV line
Adjunctive treatment
CRYSTALLOID NEBULISED BRONCHODILATORS
H1 ANTIHISTAMINE (e.g. Ringers/Balsol) (if severe bronchospasm, and especially if on beta blockers) Promethazine Rapid infusion of 1 - 2 litres (20 ml/kg for children) if no response to adrenaline Salbutamol > 12 yrs - 25 mg IM or slow IV 6 - 12 yrs - 12,5 mg IM or slow IV > 6 yrs - 5 mg every 15 - 20 mins Repeat IV infusion as necessary, as large amounts < 6 yrs - 2,5 mg every 15 - 20 mins 2 - 6 yrs - 6,25 mg IM or slow IV may be required WITH Ipratropium (Avoid if < 2 yrs old and low BP) Adrenaline infusion (0,1 - 1 ug/kg/min) ONLY if > 6 yrs - 0,5 mg every 15 - 20 mins unresponsive to IM adrenaline and fluids < 6 yrs - 0,25 mg every 15 - 20 mins
H2 RECEPTOR ANTAGONIST Ranitidine Adult - 50 mg IM or slow IV (diluted in 20 ml GLUCAGON CORTICOSTEROIDS over 2 min) Adult – 1 - 2 mg IM or slow IV every 5 mins if unresponsive to adrenaline, and especially Hydrocortisone Child – 1 mg/kg (Max - 50 mg) > 12 yrs - 200 mg IM or slow IV if on beta blockers OR 6 - 12 yrs - 100 mg IM or slow IV Child – 20 ug/kg (Max - 1 mg) 1 - 6 yrs - 50 mg IM or slow IV Cimetidine < 1 yr - 25 mg IM or slow IV Adult – 300 mg IM or slow IV (diluted in 20 ml (Look out for vomiting and hyperglycaemia) over 2 min) Child – 5 mg/kg (Max - 300 mg)
Important Information
Q When is it appropriate to initiate treatment for
Anaphylaxis? for observation for 4 - 6 hours or longer based on the severity of the reaction due to the risk of Q Why are Antihistamines considered adjunctive treatment? biphasic reaction. 2 A ANY SYMPTOMS SHOULD BE TREATED A H1-antihistamines may relieve itching and uticaria IMMEDIATELY. Do not wait for symptoms to progress. 1 Q What is the discharge protocol for patients leaving the hospital? but do not prevent or relieve life threatening symptoms of anaphylaxis. 2
Q What should happen once a patient is A Ensure patients leave with: 2
1. A referral to a specialist The use of antihistamines alone is the most common reason reported for not using adrenaline resuscitated? 2. An Anaphylaxis Emergency Action Plan and may place a patient at significantly increased A Patients must be transferred to a medical facility 3. An Adrenaline Auto-Injector risk for progression towards a life-threatening reaction.
For more information visit www.resuscitationcouncil.co.za
EPIPEN EPIPENJr ® ®
(Adrenaline) Auto-Injectors 0,3/0,15 mg
References: 1. Simons FER, Ardusso LRF, Biló MB, El-Gamal YM, Ledford DK, Ring J, et al. World Allergy Organization guidelines for the assessment and management of anaphylaxis. Proudly sponsored by: WAOJ. 2011. 2. Boyce JA, Assa’ad A, Burks AW, et al. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert Panel. J Allergy Clin Immunol. 2010;126,6:S1-S58.
EPIPEN® (Auto-injector). Reg. No.: 27/5.1/0063. Adrenaline 0,3 mg / 0,3 ml. EPIPEN Junior® (Auto-injector). Reg. No.: 38/5.1/0278. Adrenaline 0,15 mg / 0,3 mg. For full prescribing information refer to the package insert approved by the medicines regulatory authority.
