Airway and Epi! Airway and Epi! Airway and Epi!

Introduction

* Anaphylaxis is caused by massive uncontrolled release of chemicals after exposure to “antigen”* The antigen causes extensive mast cell and basophil cross-linking/activation* Common antigens* Foods* Drugs* Insect venoms

Basic Approach

* Step 1: Diagnose anaphylaxis* Consider anaphylaxis if the patient has TWO body systems involved* Dermatologic symptoms* Flushing* Rash* Urticaria* Pulmonary symptoms* Shortness of breath* Wheezing* Cardiovascular symptoms* Hypotension* Lightheadedness* Gastrointestinal symptoms* Nausea/Vomiting* Diarrhea* Step 2: Give epinepherine* A major pitfall in the treatment of anaphylaxis is delay of epinephrine!!!* Normal adult “EpiPen” contains 0.3mg epinephrine* Normal dosing of IM epinephrine is 0.01mg/kg* Step 3: Consider intubation* The second biggest pitfall in the treatment of anaphylaxis is delaying intubation until it’s extremely difficult to intubate!!!* Step 4: Give adjunct medications* H1 blocker* Diphenhydramine* H2 blocker* Ranitidine* Steroids* Prednisone, dexamethasone, etc* Step 5: Send the patient home with an EpiPen prescription* Education them on this* Articulate this part of the plan to your attending* Bonus* Refractory anaphylaxis* Beta-blockers? * Treat with glucagon

Additional Reading

* Round 10 – Allergic Reaction (EM Clerkship)* How to Use an EpiPen (YouTube)