Resuscitation: Anaphylaxis

Background:

  • Type 1 hypersensitivity reaction: release of vasoactive substance from mast cells (histamine, serotonin, tryptase poses risk of cardiovascular collapse and bronchospasm.
  • Anesthetic Triggers: neuromuscular blockers e.g. rocuronium (>60%), latex, antibiotics.
    • Most occur within minutes after induction while latex in < 1hr.
  • Incidence: 1:10,000

Treatment:

  • Call for help, inform surgeon if in OR, follow ACLS if pulseless.
  • Stop administration of all potential triggers.
  • Maintain the airway and give 100% oxygen.
  • Give EPINEPHRINE 0.5-1 mg IM or 50-100mcg. Titrate boluses every 1 min until response.
  • Secondary therapy: diphenhydramine, hydrocortisone, +/- bronchodilators
  • ICU admission to monitor for 2nd delayed reaction and if requiring vasopressors or ventilation.

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