CP01 Emergency Treatment of Anaphylactic Reactions - Devon ...

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Fig. 1 A flow chart for the emergency treatment of an anaphylactic reaction (Appendix 1) will be located in the front pocket of the bag. The pack must be easily accessible in an emergency- under no circumstances will the pack be locked away in a drug cupboard or trolley. The ward manager / clinical team leader is responsible for ensuring that all clinical staff are aware of the agreed location of the Anaphylaxis Pack on their ward / unit and all new staff must be informed of this on their first day of employment. 2.4 The Resuscitation Link Practitioner (or other designated registered nurse) will be responsible for checking and recording the expiry date of the emergency medication held on the ward and ensure the timely reordering of replacement stock. Good Practice Recommendation: Record the expiry date of all emergency medication held on the ward next to the medicine listed on the ward stock profile (Emergency Medication section). The registered nurse completing the weekly medication stock order will check the expiry date on the profile and re-order if the expiry date less than 2 weeks from the current date. 2.5 Emergency medication will be re-ordered as necessary from the pharmacy department in accordance with Standard Operating Procedure MM27 (Ordering ward stock from profiles) 3. Patient’s Own Medication (Adrenaline auto-injector devices) 3.1 Auto-injectors devices (e.g. Epipen ® ) are prescribed on an individual basis, by a specialist in allergy, for self- administration by people who are at risk of an anaphylactic reaction. 3.2 If a person on an inpatient unit experiences an anaphylactic reaction, intramuscular adrenaline (500micrograms) will be administered in accordance with this protocol (see section 2.1 and Appendix 1). However, if access to the emergency medication is delayed, it would be appropriate for a healthcare professional to use the person’s own adrenaline autoinjector (NB this may deliver a dose of 300miccrograms or 500micrograms depending on the product prescribed), for the management of an anaphylactic reaction to ensure timely administration of treatment. 3.3 For individuals prescribed an adrenaline auto-injector by a specialist or their GP, the product should be prescribed in the ‘when required’ section of the Trust inpatient prescription and administration chart to ensure clinicians are aware the person is prescribed, and usually carries, emergency medication for self- treatment of an anaphylactic reaction. 3.4 Individuals prescribed an adrenaline auto-injector should carry this with them during periods of leave away from the unit and staff must also ensure that the person’s own adrenaline auto-injector device is returned to them at the time of discharge. (Refer to procedure MM08) 4. Recognition and diagnosis of anaphylaxis 4.1 When recognising (and treating) any acutely ill patient, a rational ABCDE approach must be followed (see 4.2) and life-threatening problems treated as they are recognised. 4.2 A diagnosis of anaphylaxis is likely if a patient who is exposed to a trigger (allergen) also presents with the following; • Sudden onset and rapid progression of symptoms • Life-threatening Airway and/or Breathing and/or Circulation problems • Skin and/or mucosal changes (flushing, urticaria, angioedema) CP 01 - Protocol for the Emergency Treatment of Anaphylactic Reactions Approved by Drugs and Therapeutics Committee: March 2014 Review Date: March 2016 Page 4 of 8
Presenting signs and symptoms may include; Airway Airway swelling (throat & tongue), difficulty breathing and swallowing, sensation of throat closing up, hoarse voice, stridor (loud, harsh, high-pitched breathing) Breathing problems Shortness of breath (increased respiratory rate), wheeze, fatigue, confusion caused by hypoxia, cyanosis (blue-tinge to the skin), respiratory arrest. Some patients may die from acute irreversible asthma or laryngeal oedema with few more generalised manifestations present. Circulation Signs of shock (pale, clammy), tachycardia, hypotension, dizziness, collapse, reduced or loss of consciousness and faint carotid pulse. Disability Airway, breathing and circulatory problems can all alter neurological status causing confusion, agitation and loss of consciousness. Continued….. Exposure (Skin and/or mucosal changes) Urticaria can appear anywhere on the body. Wheals may be pale, pink or red and may look like a nettle sting. They can be different shapes & sizes, often surrounded by a red flare and usually itchy. Angioedema most commonly affects eyelids and lips and sometimes the mouth and throat. Skin or mucosal changes alone are not a sign of an anaphylactic reaction and can be subtle or absent in up to 20% of reactions. Other Gastrointestinal (vomiting, abdominal pain, incontinence), rhinitis and conjunctivitis. 4.3 Differential Diagnosis: Non-life threatening conditions which can be confused with anaphylaxis include: 4.3.1 Panic attacks Individuals who have previously experienced an anaphylactic reaction may be particularly prone to panic attacks if they think they have been re-exposed to the causative allergen. The sense of impending doom and breathlessness leading to hyperventilation may resemble anaphylaxis, however there is no hypotension, pallor, wheeze, or urticarial rash/swelling. An erythematous rash associated with anxiety may complicate diagnosis, whereas overbreathing, tingling around the lips and muscle spasms in the fingers are usually associated with panic attacks. 4.3.2 Vasovagal Attacks Vasovagal attacks (vagal overactivity producing bradycardia and a fall in blood pressure) can occur following vaccination and administration of intra-muscular injections (i.e. antipsychotic depot injections) and can be misdiagnosed as anaphylaxis. However, the absence of rash, breathing difficulties, and swelling is a useful distinguishing feature as is the slow pulse and normal blood pressure (compared with the rapid pulse and low/undetectable blood pressure of a severe anaphylactic episode). 5. Treatment 5.1 Treatment of an anaphylactic reaction should be based on general life support principals: Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) 5.2 In all cases of suspected anaphylactic reactions, immediately shout for assistance and an anaphylaxis pack. Medical help must be urgently sought by calling 999 from an outside line. 5.3 The person should NOT be left unattended. From when the reaction is identified until the emergency services arrive, the person must not be left alone. CP 01 - Protocol for the Emergency Treatment of Anaphylactic Reactions Approved by Drugs and Therapeutics Committee: March 2014 Review Date: March 2016 Page 5 of 8
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CP01 Emergency Treatment of Anaphylactic Reactions - Devon ...

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