Foundations of Interprofessional Collaboration (FIPC): An Introduction to TeamSTEPPS® LEVEL 3 Overview of Clinical Management of Anaphylaxis for Respiratory Students

Anaphylaxis Definition “A serious allergic reaction that is rapid in onset and may cause death.” National Institute of Allergy and Infectious Disease and the Food Allergy and Anaphylaxis Network

Exposure Food Drug Environment

Exposure Immune Reaction Symptoms Skin Respiratory GI CVS

Skin Itching Flushing Hives Angioedema

RESPIRATORY Cough Dyspnea Hoarseness Stridor Wheeze Desaturations

GI Nausea Vomiting Diarrhea Abdominal pain

CVS Dizziness Hypotension Shock Incontinence

Respiratory Acute illness within minutes – Act quickly – life threatening Dyspnea Stridor Wheezing Bronchospasm Hypoxemia Support Airway Oxygen – for desaturations Breathing Treatment for bronchospasm Monitor patient for respiratory failure Be prepared to provide rescue breathing and intubate if needed

Consider second line medications: Identify an Event Lead (Assigns roles and monitors situation) Assess & Communicate with Patient (Physical exam, keep informed, obtain history, monitor vital signs & overall status) Consider second line medications: Methylprednisolone 1 mg/kg H1 antihistamine: Diphenhydramine 25 mg IV H2 antihistamines: Cimetidine 4 mg/kg IV Identify patient with possible anaphylaxis Review Patient Chart for relevant History (Other possible diagnoses? Possible causes of anaphylaxis?) Identify & remove trigger Epinephrine 0.3 mg IM (Can repeat in 5-15 minutes) Consider alternative diagnoses and additional testing (consider confirmatory testing (tryptase)) Fluid Bolus Start Oxygen and Bronchodilator (Albuterol 2.5 mg in 3 mL of saline) Anaphylaxis Practice Parameter; Annals of Allergy Asthma & Immunology; 2015; 115: 341-384.

Additional Inpatient Medications for Anaphylaxis Bronchodilator Albuterol 2.5 mg in 3 mL normal saline Nebulized Corticosteroids Limited evidence to support use but often given to prevent second phase of anaphylaxis Onset 4-6 hours Methylprednisolone 1 mg/kg/day IV push Antihistamine (H1 and H2 Antagonists) Limited evidence to support use but often administered to treat urticaria Diphenhydramine 25 mg IV push Cimetidine 4 mg/kg IV infusion or Ranitidine 50 mg IV push

Role of Respiratory Therapist in Rapid Response Team Collect information (or provide input for team leader) related to airway status Assist team in assessing the patient and provide assessments related to medication therapy Provide therapeutic recommendations (e.g., therapy options, dosing, monitoring) Prepare respiratory medications and deliver Provide mutual support to other members of the team as needed