Allergies/Anaphylaxis

Anaphylaxis

• What• An exaggerated immune response

to a substance • Antigen/Antibody Reaction gone

“haywire”• Pathophysiology

• Body overreacts to exposure to an antigen and the associated antigen/antibody complex results in the release of many damaging substances

• Antigen • Substance recognized as

foreign by the body• Antibody

• Protein of the body that binds to antigen

• S/S• S/S seen in many organ systems

• Respiratory – Circulatory – GI – Skin

• Diffuse and severe

Anaphylaxis v Allergic Reaction

• Difference in extent/scope of reaction

• Allergic reaction • Local & relatively mild

• Anaphylaxis • Diffuse and severe

• Onset• Extremely rapid

• Death within minutes• Histamine release

• Vasodilation and leakage• Hypotension/shock• Swelling of tissue

and airway • Treatment

• Reverse effects of reaction• Maintain open airway • Stabilize cardiovascular system • Epinephrine auto injector

AnaphylaxisComplications

• Constriction of smooth muscle• Bronchoconstricion= SOB/ Airway obstruction• GI constriction= Cramping, vomiting, diarrhea

• Increased permeability of capillaries• Leakage of plasma and proteins into tissue• Edema and loss of blood volume

• Dilation of arteries• Decreased peripheral resistance – Decreased BP

• Dilation of veins • Venous pooling • Low venous return • Decreased cardiac output and low BP

• Increased mucus production• Further increased work of breathing and SOB• Increased GI symptoms

• Respiratory Failure• Circulatory collapse

Anaphylaxis Assessment

• Scene Size Up• Scene safe/BSI

• Initial Assessment• Closely monitor ABC’s• Be alert for shock • Supplemental O2

• Focused Hx & Px Assessment • Focused Hx

• SAMPLE, OPQRST Hx• Baseline Vitals • Hx of allergies• -Medic alert tags –Epi Pen • What was the pt exposed to• How were they exposed • What effects• Progression• Possible self administration of

drug(s)

Anaphylaxis Sings/Symptoms

• Warm/tingling sensation in: face, lips, mouth, chest, feet, hands

• Itching• Hives • Red skin (flushing) – (Diffuse

vasodilation) • Swelling to: hands, feet,

neck, tongue, etc (angioedema)

• Tightness in chest/throat- Dyspnea (bronchoconstricion)

• Cough• Rapid, labored, noisy

breathing• Hoarseness • Stridor

• Wheezing• Increased heart rate• Hypotension • Itchy, watery eyes• Headache• Sense of impending doom• Runny nose• AMS• Lethargy• Anxious• Nausea, vomiting, abd

cramps • Cardiorespiratory arrest

Angioedema Hives Vomiting

Respiratory Distress

Anaphylaxis Management

• Administer life saving medication• Epinephrine

• Respiratory support• NRB if distress• BVM if severe distress/failure/arrest• ALS intercept

• Cardiovascular Support• Shock position if S/S noted • Rapid transport• Nothing PO• ALS intercept• Vitals q 5 minutes

Epinephrine Pharmacology

• Generic- Epinephrine• Trade- Adrenaline • Indications

• S/S of anaphylaxis • Pt has epi pen prescribed by physician• Medical direction orders

• Contraindications• None when used in a life threatening situation

• Form• Liquid administered via an automatically injectable needle and syringe system

• Dosage• Adult – 1 adult auto injector (0.3 mg)• Child/infant – 1 infant/child auto injector (0.15 mg)

• Route• Mid lateral aspect of the thigh

• Actions• Bronchodilation• Vasoconstricion

• Side effects• Increased heart rate, Pallor, Dizziness, Chest pain, Headache, Nausea/vomiting,

Excitability/anxiousness

Epinephrine Administration

• Obtain order from medical control • Obtain pt prescribed auto injector

• 5 Rights• Epi is not discolored

• Remove safety cap from the epi pen• Place tip of auto injector against pt thigh

• Lateral portion of the thigh• Midway b/t waist and knee

• Push the injector firmly against thigh until it discharges• Hold the injector in place until all the med has been given

• 10-15 seconds• Record activity and time• Dispose of the epi pen in a biohazard container• Reassess vitals

Anaphylaxis Management

• Transport Decision • Immediate administration of Epi if pt has Epi Pen• If pt does not have an Epi pen

• Load and transport immediately• ALS intercept

• If pt has no S/S shock/resp distress• Continue with focused assessment• These pt can quickly progress to distress, failure, and arrest • Do not give Epi

Anaphylaxis Reassessment

• Re-assessment • Transport• Continue Focused Assessment of ABCs• If pt deteriorates

• Decreasing LOC• Increasing SOB• Decreasing BP• Treat for shock• Prepare for BLS interventions

• CPR• AED

• Obtain medical direction• Additional dose of epi

• If pt improves • Oxygenate• Treat for shock if S/S noted