Anaphylaxis

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9 • 816 Ratings

🗓️ 1 October 2017

⏱️ 10 minutes

🔗️ Recording | iTunes | RSS

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Summary

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)

Transcript

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0:00.0	Hello, med students. My name is Zach Olson, and thank you for downloading this week's
0:06.7	episode of the EM Clerkship Podcast. Critical diagnosis this week, here's your case.
0:25.5	Okay, we have a 32-year-old male called originally for the choking victims.
0:31.2	Patient states he can't swallow and was having a hard time breathing stated an allergy to shellfish,
0:32.6	and then we almost lost the airway.
0:35.0	Unknown meds, no medical history except for the allergy.
0:37.3	He got 0.5 of 1 to 1,000,000 epi. He got an 18 gauge line
0:38.6	to left AC. He did get 50 milligrams Benadryl IV and we did for a bolusum 400 milliliters
0:44.1	of normal sailing. Repeated with point three right when we're in the bay just now and as you
0:48.8	can see he's starting to kind of revert. Any questions? All right. Thank you.
1:09.2	Anaphylaxis. Say it with me. Airway and epi. Airway and epi. The most important thing that you need to know forever about anaphylaxis is airway and epi.
1:14.6	Airway and epi. They have studied this. We are not giving airway and epi enough attention.
1:21.0	We aren't doing it enough. Airway and epi for anaphylaxis. I don't care what the question is on the test.
1:27.0	I don't care if they have anaphylaxis to airways and epi. I don't care. Airway and epi is the right answer to anaphylaxis. Drill it into your head, airway and epi. That steps one, two, three, four, five every time. That's the big can't miss test question, airway and epi. let it sink in while we talk physiology which is also
1:46.7	super important and while we cover the rest of the approach airway and epi so let's go what is
1:55.4	anaphylaxis in anaphylaxis the antigen that the patient is exposed to, typically a food, drug, or some sort of insect venom, floats to their mast cells and their basophils and cross-links those IGE receptors, causing massive, uncontrolled release of stuff.
2:18.2	Histamine and triptase and proteoglycans and all this crap, antigen exposure and boom,
2:24.9	massive physiologic influx of stuff into the circulation.
2:29.6	Immediate total body chaos.
2:31.7	That's anaphylaxis.
2:32.9	It's deadly.
2:33.6	It's a big emergency. That's how it works. It's deadly. It's a big emergency. That's how it works.
	...

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