Adult Medical Emergency Handbook - Scottish Intensive Care Society

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ANAPHYLAXIS
Anaphylaxis is an acute allergic process where a substance to which
the individual has been previously exposed results in mast cell
degranulation and massive mediator release. Anaphylactic shock is
twice as common in women and atopy is present in about a third of
cases.
Aetiology
• Foods: nuts, fish.
• Drugs: NSAIDs, antibiotics, anaesthetics.
• Stings
• Idiopathic
Presentation
There is a spectrum of severity from mild to catastrophic, and treatment
must be tailored to the individual situation.
Clinical features
• Airway compromise and breathing difficulties: stridor, wheeze,
tachypnoea.
• Circulatory collapse: hypotension, tachycardia.
• Itch, skin rash, angio-oedema - may be absent.
• In about 20% abdominal or muscle pain or GI upset are major
symptoms.
ACUTE ANAPHYLAXIS
Bronchospasm and/or cardiovascular collapse.
Adrenaline should be given to all patients with respiratory
difficulties and/or hypotension.
1. Immediate action
O 2 + Help
Adrenaline
IV Fluids
• Discontinue administration of suspect drug, blood transfusion
or IV fluid.
• GET HELP - call 2222.
• ABC: maintain airway and give 100% oxygen by high flow with
oxygen mask and reservoir bag or bag/mask/valve apparatus.
Intubation may be required early, particularly if stridor is present.
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
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