1. Dr.Soma Sekhara Reddy.kEmergency Physician

2. OBJECTIVES Definition Epidemiology Pathophysiology Clinical features Management prevention 3. AGAINST PROTECTION ANA - Against PHYLAX - Guard Pharoh Menes - 2641 BC 4. DEFNITION Serious allergic reaction that is rapid in onset and may causedeath. Multi organ involvement Precipitated with in minutes of exposure to a particular allergen In a sensitized patient 5. Clinical criteria for Anaphylaxis1.Acute onset of illness with involvement of skin and/ormucosal tissue along withResp.compromise / hypotension / associated symptomsof organ dysfunction2.Rapid onset of 2 0r more of the following after exposure tolikely allergen:Involvement of skin and/or mucosal tissueResp.compromiseHypotensionG I symptoms3. Known allergen with hypotension 6. EPIDEMIOLOGY Food Insect stings Pharmacological agents Latex Exercise Unidentified Idiopathic anaphylaxis 7. RISK FACTORS Low in very young and very old Dose,frequency,route Poorly controlled asthma Previous anaphylaxis 8. PATHOPHYSIOLOGYTwo staged process: Sensitization Degranulation 9. SENSITIZATION 10. DEGRANULATION Re exposure mast cell degranulates Releases several chemicals Acts on target organs Clinical syndrome of anaphylaxis 11. TARGET ORGANS Rich in mast cells Skin Eye Nose Resp tract GIT CVS 12. CHEMICAL MEDIATORS Histamine Tryptase Chymase Cathepsin G TNF Proteoglycans 13. CLINICAL MANIFESTATIONS- RS Rhinitis Pharyngeal and laryngeal edema Cough Broncospasm Dyspnea / chest tightness 14. CLINICALMANIFESTATIONS - CVS Dysrhythmia Hypotension Cardiac arrest 15. CLINICALMANIFESTATIONS - skin Generalized warmth and tingling Pruritis Urticaria flushing Angioedema 16. CLINICALMANIFESTATIONS - GIT Abdominal pain / cramps Nausea Vomiting Diarrhea ? Gi bleed 17. TREATMENT FIRST LINE SECOND LINE 18. FIRST LINE THERAPY Airway Breathing Circulation IV O2 monitor 19. FIRST LINE THERAPY EPINEPHRINE Drug of choice IV/IM 20. EPINEPHRINE IV Severe upper airway obstruction Acute respiratory failure Shock Caution but not contra indicated.. 21. EPINEPHRINE Dose 100 microgram (0.1 mg) bolus over 5 to 10 mins 0.1 ml of 1:1000 diluted in 10 ml NS Start infusion if there is no response (1-4 mic/min) 0.1 mic/kg/min in children Stop if chest pain or arrhythmia occurs 22. EPINEPHRINE IM LESS SEVERE SYMPTOMS Dose: 0.3 -0.5 ml of 1:1000 May be repeated every 5 to 10 mins Antero lateral thigh is preferred over deltoid 23. FIRST LINE THERAPY Decontamination 24. FIRST LINE THERAPYFLUIDS 1-2 L of NS bolus 20 ml/kg bolus in children 25. SECOND LINE THERAPYCORTICOSTEROIDS Methyl prednisolone 80 -125 mg IV (2mg/kg) Hydrocortisone 250- 500 mg IV (5 -10 mg/kg) Oral prednisolone 26. SECOND LINE THERAPYANTI HISTAMINES H1 blocker- Diphenhydramine/CPM 25 50 mg IV H2 blocker - Ranitidine 50 mg IV Avoid cimetidine 27. SECOND LINE THERAPYAEROSOLISED BETA AGONISTS Salbutamol Levosalbutamol Ipratropium bromide Severe persistent cases magnesium may be used 28. SECOND LINE AGENTSGLUCAGON Reserved for patients on beta blockers and refractory to initialmeasures 1 mg IV every 5 minutes until hypotension resolves followed by5 15 mics / min infusion. Side effects: Hypokalemia , hyperglycemia , nausea , vomiting. 29. PREVENTION Allergy history Label all loaded syringes Give drugs in distal extremity whenever possible Ensure all patients wait in ED for atleast 30 mins after any drugadministration 30. PREVENTION Warning identification Avoid any known allergens Epipen Use allergy bands for all predisposed patients. 31. TAKE HOME Always ABC first Epinephrine is the drug of choice Anaphylaxis is very near to severe allergic reactions Change beta blockers Put on long term steroids if it is idiopathic anaphylaxis Educate every patient about prevention 32. Thank you