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

2. 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

3. Exposure
Food
Drug
Environment

4. Exposure
Immune Reaction
Symptoms
Skin
Respiratory GI
CVS

5. Skin
Itching
Flushing
Hives
Angioedema

6. RESPIRATORY
Cough
Dyspnea
Hoarseness
Stridor
Wheeze
Desaturations

7. GI
Nausea
Vomiting
Diarrhea
Abdominal pain

8. CVS
Dizziness
Hypotension
Shock
Incontinence

9. 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

10. 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:

11. 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

12. 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