Adult Medical Emergency Handbook - Scottish Intensive Care Society

URTICARIA AND ANGIO-OEDEMA
• These conditions are sub-acute or chronic unless they accompany
anaphylaxis or the airway is involved by swelling.
• Sudden total airway obstruction can result and is rapidly fatal
unless oxygenation is maintained.
Management
• Airway compromise: if stridor is present and airway obstruction
imminent endotracheal intubation is mandatory (GET HELP).
• Give high concentration oxygen. Intubation may be difficult: fast
bleep (2222) anaesthetics and ICU.
• In severe cases of urticaria/angio-oedema adrenaline should be
given as for anaphylaxis: 500 micrograms im (0.5ml 1 in 1000
solution) or using the IV schedule detailed above.
• If total upper airway obstruction occurs oxygenation must be
maintained via emergency cricothyrotomy. Kit in A&E, ARAU,
Theatres and ICUs.
• May be more resistant to drug treatment than anaphylaxis and
need early intubation. Often a very difficult procedure.
• Nebulised adrenaline may be effective.
• Antihistamines and steroids are used as for anaphylaxis.
LIFE-THREATENING UPPER-AIRWAY OBSTRUCTION
Inability to get gas in by patient or by attendants.
• Causes include foreign body, swelling (anaphylaxis, angio-oedema
see above), trauma, burns and peri-anaesthetic (laryngospasm).
• Administer 100% oxygen via BMV and call for Anaesthetic/ICU
HELP.
• May need to contact ENT surgeons for definitive airway.
adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11
77