Adult Medical Emergency Handbook - Scottish Intensive Care Society

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• Commence basic life support (CPR) if no pulse present.
• Secure adequate IV access if not already.
• Monitor oxygen saturation and BP.
• ECG must be continuously monitored, and a defibrillator
immediately available.
• Give adrenaline 500 micrograms intramuscular (0.5ml of 1 in 1000
solution). Repeat in 5-10 mins if no better or getting worse.
• Give IV fluids. Hartmann’s solution, 0.9% saline or Gelofusine 10ml/
kg (about 500ml to 1 litre) can be used initially. Colloid may be more
efficient at restoring blood volume especially in severe cases.
2. Supplementary action to damp down inflammation/prevent
recurrence
• Give hydrocortisone 200mg IV (slowly).
• Give antihistamines: chlorphenamine (chlorpheniramine) 10-20mg
IV slowly.
• Give salbutamol 5mg nebuliser if wheeze present.
• Measure arterial blood gases and coagulation.
VERY SEVERE ANAPHYLAXIS
Most cases will resolve with the above treatment. However in
the most severe cases with life-threatening shock or airway
compromise, particularly in association with general anaesthesia,
adrenaline should be given intravenously as described here.
• This is a rapidly life-threatening condition requiring experienced
clinical management. Intravenous adrenaline boluses should only
be given by, or under the direct supervision of, an appropriately
experienced clinician.
• Give ADRENALINE INTRAVENOUSLY (especially in the presence
of stridor or wheeze) starting with 50 to 100 micrograms (0.5-1
ml of 1 in 10,000 i.e. Minijet), with further 50 to 100 microgram
aliquots as required.
• Adrenaline dose in cardiac arrest is 1 mg (10ml of 1 in 10,000).
SUBSEQUENT ACTION
Record allergy prominently in notes and explain to patient and family.
CONTINUING PROBLEMS (requiring ICU referral for:)
Severe and resistant bronchospasm
74 adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11