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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