Simulation Medicine and Scenario-Based Learning

Simulation medicine and Scenario-based learning
for emergency care

for emergency care
Anaphylactic shock
Anaphylactic shock
• Anaphylaxis is a serious systemic allergic reaction that is rapid in onset

and may cause death.
• The incidence of anaphylaxis is increasing globally, whereas the case
fatality rate has remained stable or decreased, with an overall
population risk of death of about 0.5-1 per million.
• Foods (especially in children), drugs and insect bites are the
commonest triggers
Anaphylactic shock
• Recognition of anaphylaxis
• Anaphylaxis causes:
• Life threatening airway (swollen lips, tongue, uvula)
• Life threatening breathing (dyspnoea, wheeze, bronchospasm, stridor,
reduced peak flow, hypoxaemia)
• Life threatening circulation problems (hypotension, cardiac arrest)
• with or without skin or mucosal changes (generalised urticaria,
flushing or itching) as part of an allergic reaction
• Treat life-threatening features, using the Airway, Breathing,
Circulation, Disability, Exposure (ABCDE) approach
Anaphylactic shock managment
1. Remove or stop the trigger if possible

2. Intramuscular adrenaline
• Give intramuscular adrenaline early and repeat after 5 min if necessary:
adrenaline its alpha- (vasoconstrictor) and beta-(bronchodilator, inotropic,
mast cell stabilisation) agonist properties
• Intramuscular (IM) adrenaline works within minutes and adverse effects are
extremely rare with the correct doses
• ERC guidelines recommend a dose of 0.5 mg IM in adults based on expert
opinion and suggest repeating the IM adrenaline dose if there is no
improvement in the patient’s condition after about 5-min
Anaphylactic shock
3. Give intravenous fluids

• Anaphylaxis can cause hypotension due to vasodilation, redistribution of
blood between vascular compartments, and fluid extravasation and correcting
for fluid losses in addition to adrenaline is based on experience of managing
shock in other settings such as sepsis.
• Use of either balanced crystalloids or 0.9% sodium chloride bolus doses and
further doses based on haemodynamic response. The first resuscitation fluid
bolus should be about 500 ml over 5 - 10 min.
4. Give oxygen
• Oxygen therapy to correct hypoxaemia is a standard part of resuscitation.
Anaphylactic shock
5. Other drugs to support the circulation

• Glucagon 1-2 mg IV is considered for anaphylaxis refractory to adrenaline in
patients who are taking beta-blockers
6. Role of steroids and antihistamines in the immediate management
of anaphylaxis
• Steroids should be considered if there are ongoing asthma-like symptoms or
in the setting of refractory shock in accordance with guidelines for asthma
and shock states
for emergency care
Intoxications
Drug overdose
• An overdose can occur after someone consumes a toxic level of a

substance (or multiple substances) and the effects of this interfere
with their brain and body’s ability to function properly.
• Drug overdose can be fatal; however, when it isn’t, overdose-related
toxicity can result in several negative short-term and long-term health
consequences
Drug overdose
• Overdose symptoms can vary and sometimes it is hard to differentiate

between relatively less severe side effects of a drug and the
symptoms of a life-threatening overdose.
• A wide range of drugs can cause overdose, including:
• Alcohol.
• Opioids, including heroin, fentanyl, and prescription painkillers.
• Benzodiazepines.
• Stimulants, including methamphetamine, cocaine, and many others
Symptoms of an Overdose
• Potential signs and symptoms of an alcohol overdose include:

• Marked mental confusion or stupor.
• Difficulty remaining conscious (or being completely unconscious).
• Lack of responsiveness, or being unable to be roused or woken up by others.
• Seizures.
• Vomiting (particularly dangerous given the potential for diminished gag
reflex).
• Slowed or irregular breathing.
• Heart rate that slows or stops.
• Very low body temperature.
• Pale or blue-tinged, clammy skin.
• Potential signs and symptoms of an opioid overdose include:

• Loss of consciousness.
• Markedly constricted or pinpoint pupils.
• Breathing difficulties (slowed, labored, and/or irregular breathing).
• Respiratory arrest (completely stopped breathing).
• Choking, gurgling, or snoring sounds.
• Blue or purple lips or fingertips.
• Being unresponsive to loud noises, shaking, or painful stimuli.
• Potential signs and symptoms of benzodiazepine overdose include:

• Profoundly impaired mental status.
• Marked confusion.
• Slurred speech.
• Slowed, labored breathing or respiratory arrest.
• Coma.
• Potential signs and symptoms of stimulant overdose include:

• Dangerously increased body temperature.
• Hyperventilation or rapid breathing.
• Rapid or irregular heartbeat.
• Very high blood pressure.
• Devastating cardiovascular events (e.g., stroke, heart attack, circulatory
compromise).
• Panic.
• Hallucinations.
• Paranoia and other features of psychosis.
• Aggressive behavior.
• Seizures and convulsions.
Treatment of an Overdose
Treatment of an Overdose

Simulation Medicine and Scenario-Based Learning - Day 2 - Section 2

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for emergency care

• Anaphylaxis is a serious systemic allergic reaction that is rapid in onset

1. Remove or stop the trigger if possible

3. Give intravenous fluids

5. Other drugs to support the circulation

• An overdose can occur after someone consumes a toxic level of a

• Overdose symptoms can vary and sometimes it is hard to differentiate

• Potential signs and symptoms of an alcohol overdose include:

• Potential signs and symptoms of an opioid overdose include:

• Potential signs and symptoms of benzodiazepine overdose include:

• Potential signs and symptoms of stimulant overdose include:

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