RESUSCITATION TECHNIQUES IN ANAPHYLAXIS

B Y

A N U G O M E M E K A M B B C H , M P H , M S C O C C M E D , I G C N E B O S H

WELCOME & INTRODUCTIONS

Logistics Emergency exits Restrooms

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AGENDA

Introduction

What is Anaphylaxis

Causes of Anaphylaxis

Epidemiology

Management of Cardiac arrest in Anaphylaxis

Supportive Management for Anaphylaxis

Conclusion

References

Q&A

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INTRODUCTION

Various difficult situations may arise that lead to cardiac arrest.

The skill of bystanders is paramount for outcome of survival.[1]

Resuscitation will need to be modified in these situations depending on their peculiarities and reversible causes.

Early recognition and proper management of Airway Breathing Circulation Disability and Exposure (ABCDE) is very important for survival.[2]

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INTRODUCTION

This presentation is a review based on 2010 Guidelines by American Heart Association and European Resuscitation Council.

Prior Knowledge of current BLS/ACLS guidelines or resuscitation is assumed.

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WHAT IS ANAPHYLAXIS?

A Multi-systemic life-threatening hypersensitivity reaction that may lead to cardiopulmonary collapse.[3,4]

Commonly misdiagnosed especially if it is not life-threatening.[3]

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CAUSES OF ANAPHYLAXIS?

It is mostly idiopathic

but may arise from common triggers like :

- Food (especially in children)

- Drugs (especially in adults)

- Insect bites

- Latex etc.[3,4]

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EPIDEMIOLOGY

The annual frequency of episodes is 30 to 950 cases per 100,000persons[3,4]

There is a life time prevalence of 0.05 to 2%[3,4]

It accounts for 50 to 100 deaths annually in the United States.[3,4]

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http:/ /www.webmd.com/al lergies/anaphylaxis-13/sl ideshow-al lergy-tr iggers Image 2: http:/ /en.wikipedia.org/wiki /Anaphylaxis

MANAGEMENT OF CARDIAC ARREST IN ANAPHYLAXIS

In the event of a cardio-respiratory arrest arising from anaphylaxis, normal BLS and ACLS guidelines are to be followed.[2,3,4]

There is need to monitor the following parameters for diagnosis and evaluation :

- Pulse

- Blood pressure

- ECG

- Arterial blood gases

- Elecrolytes

- Chest X-ray and

- Mast cell tryptrase [3,4]

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MANAGEMENT OF CARDIAC ARREST IN ANAPHYLAXIS

Insert advanced airway early via

- intubation or

- cricothyroidotomy

This MUST be done quickly because of risk of soft tissue swelling

Ensure ventilation with Bag valve mask.

Administer Epinephrine(Adrenaline) parenteral:

- Intramuscular or

- Intravenous (To be given by experts only).[3,4]

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MANAGEMENT OF CARDIAC ARREST IN ANAPHYLAXIS

CPR maybe prolonged in this case. [3,4]

Fluid resuscitation with isotonic crystalloids like normal saline is also important. [3,4]

Administer high concentration and

high flow oxygen to the patient. [3,4]

Other vasoactive drugs and inotropes can also be utilized if they are non-responsive to epinephrine like:

- Vasopressin

- Noradrenaline etc. [3,4]

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http:/ /www.gponl ine.com/managing-anaphylaxis-during-emergency/al lergic-disorders/anaphylaxis/art icle/1052048

SUPPORTIVE MANAGEMENT FOR ANAPHYLAXIS

Other supportive management that may be beneficial includes :

use of Antihistamine H1 and H2 antagonists

IV Corticosteroids

Inhaled/IV Bronchodilators and

Extracorporeal support like Cardiopulmonary bypass[3,4]

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CONCLUSION

Difficult situations may arise or lead to need for resuscitation.

Modifications and consideration of reversible factors, including importance of making early decisions to

- initiate resuscitation

- invite expert and

- manage the patient accordingly

is paramount to survival in these situations.

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CONCLUSION

Mastery and awareness of the basic techniques and guidelines for BLS/ACLS by everyone is crucial to success in resuscitation in theses situations.

Get Trained to save lives.

14 Image: http://en.wikipedia.org/wiki/Cardiopulmonary_resuscitation

REFERENCES

1. J.R Casal Codesido, y M.J. Vazquez Lima, 2007; Out-of Hospital Cardiopulmonary Resuscitation: Where are We now? Emergencias 2007;19:295-297.

2. Australian Resuscitation Council; New Zealand Resuscitation Council, 2011; Guideline 11.10 Resuscitation in Special Circumstances: 1-14

3. Jasmeet Soar et al,2010, European Resuscitation Council Guidelines for 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma,anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution; Elsevier Ireland Ltd, Resuscitation 81(2010)1400-1433, doi:10.1016/j.resuscitation.2010.08.015

4. Terry L. Vanden Hoek et al, 2010, Cardiac Arrest in Special Situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care; Circulation.2010:122:S829-S861; doi:10.1161/CIRCULATIONAHA.110.971069; Online ISSN:1524-4539

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QUESTIONS

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