Guidelines for the management of anaphylaxis in the emergency department.

Abstract

An algorithm for the emergency treatment of anaphylaxis is presented. The need for early hands-on involvement of senior personnel is stressed. Continuous assessment, monitoring of response to treatment, and a low threshold for hospital admission for observation and further treatment if necessary are required. (7 Accid Emerg Med 1998;15:96-98)

The modern aspects of anaphylaxis therapy

“…Fall in systolic blood pressure of more than 20 mm Hg and tachycardia are features of moderate anaphylaxis and should be treated with 10 ml/kg colloid intravenous fl uid. If severe cardiovascular collapse occurs, higher volumes (20 ml/kg) should be infused [27].…”

“…In patients with cardiac arrest or severe hypotension unresponsive to intramuscular doses of epinephrine, intravenous (i.v.) application is an option [2,10,18,27]. Also, it was observed that the subcutaneous (s.c.) administration of adrenaline leads to prolonged but variable absorption related to local vasoconstrictor action and this potential for variability is clearly unacceptable in the critically compromised or shocked patients [14].…”

“…If needed, epinephrine may judiciously be repeated in both adults and children. Th e interval between doses should be 5-30 minutes [7,27,28] whereby repeated doses of adrenaline are indicated until clinical improvement is achieved [10]. Patients usually respond to 1 or 2 doses [12].…”

“…An adrenaline dilution of 1:10 000 or greater (1: 100 000) is recommended for the i.v. route; half the dose should be given very slowly while monitoring the patient's vital signs and the rest should then be given in small aliquots if there are no adverse eff ects [2,27,32]. Samson et al [2] indicated that continuous low-dose epinephrine infusions might have the advantage over large boluses of epinephrine as represents safer and more eff ective form of delivery because the dose can be titrated to the desired eff ect whereby avoiding the potential for acci-dental administration.…”

“…Intravenous salbutamol or glucagon administration, or both, should be considered if the patient is on a β-blocker used and appear to have more frequent and severe anaphylactic reactions, resistant to standard therapy [14,27,29]. β2-agonists are useful adjuvants in treating bronchospasm associated with anaphylaxis and may be administered by inhalation or intravenously [10,18].…”