Refractory Anaphylaxis

anaphylaxis anaphylaxis management anaphylaxis triggers patient safety refractory anaphyalxis May 13, 2024
Anaphylaxis will respond to standard management in 95% of cases. For the other 5%, your team needs a plan. The ANZAAG Anaphylaxis Management Guidelines have a card for this scenario. Here is an outline of what’s involved: 👇🏼👊😎
 
1️⃣ Request more help
👉 Consider pressing the emergency bell or requesting experienced assistance
 
2️⃣ Triggers
👉 Check again if there are any possible triggers still being administered. These may include latex, chlorhexidine or synthetic colloids.
 
3️⃣ Monitoring
👉 Consider placing an arterial line
👉 Consider the use of echocardiography (TTE/TOE)
 
4️⃣ For resistant hypotension
👉 Additional 50ml/kg bolus of crystalloid
👉 Noradrenaline infusion
👉 Vasopressin bolus and infusion
👉 Glucagon bolus (for beta blocker reversal)
👉 Remember to ensure manual left uterine displacement in pregnant patients
 
5️⃣ For resistant bronchospasm
👉 Rule out oesophageal intubation, circuit malfunction, tension pneumothorax
👉 Continue adrenaline infusion
👉 Add bronchodilators
🔺 Salbutamol
🔺 Magnesium
🔺 Volatiles
🔺 Ketamine
 
6️⃣ Consider other diagnoses!
 
Build knowledge ✅
Improve safety ✅
 
Ref: https://anzaag.com/anaphylaxis-management/management-resources/

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