2. ADULT EMERGENCY CARE AND RESUSCITATION Jan Heath Chapter 32

3. Introduction This chapter will walk you through an emergency care and resuscitation situation (anaphylax shock). At various stages you will be asked to stop and consider your next action. You can refer back to the printed chapter for more advice if you’re uncertain.

4. Q. What clinical presentation should you be looking for with anaphylaxis?: Clinical Presentation

5. You should be looking for: Local inflammation Swelling As well as more complex problems: Bronchoconstriction Vasoldilation

6. Q. Identify 10 things which can trigger an anaphylactic reaction. Causes

7. There are a host of possible causes, for example: Food e.g. sea food, peanuts, sesame, strawberries, dairy products Drugs e.g. aspirin, antibiotics Latex Stinging insects, e.g. bees, wasps You should looks for evidence of the cause.

8. Symptoms Q. Identify 10 symptoms of anaphylaxis

9. Symptoms of Anaphylaxis Conjunctivitis Itching of palate/external auditory meatus Nausea, vomiting, abdominal pain Palpitations Sense of impending doom Erythema Generalised pruritis Urticaria Angio-odema Wheeze

10. Q. If you find someone in anaphylactic shock, what should you do? Action

11. Ask for help Call 999 Put the patient in a position where he could breathe easily

12. Q. What treatment would you provide to someone with an anaphylactic reaction? Treatment

13. Put the victim in a position where they are able to breathe more easily if possible Loosen tight clothing and take a history from the victim or anyone who was present at the time Give 100% oxygen if possible Administer adrenaline The adult dose for Adrenaline IM (intramuscularly) is: 500mcgs = 0.5mls 1:1,000 Repeat after 5 minutes if there is no improvement Patients with a known allergy may carry their own auto-injector, which is 300mcgs for IM use.

14. Clinical Progress Q. What would you do if the patient fell unconscious?

15. Call for help (if not done so already) Rehearse what you would say under such circumstances if you had to make the call. Commence life support.

16. Basic Life Support (BLS) What is the ratio? 30 compressions to 2 breaths How many chest compressions over a minute? 100 When the ambulance crew arrive, they may: Intubate the trachea Administer adrenaline via the endotracheal tube

17. Care in the Clinical setting Following transfer to a hospital high dependency unit, the patient will receive: Observations hourly ECG monitoring Oxygen saturations Respirations Chest X-ray ECG