Recognition and Emergency Treatment of Anaphylaxis (Severe Allergic Reaction)
It can be difficult to recognise anaphylaxis due to the diversity of symptoms that people develop. I always encourage learners that if you are acting within the best interests of the person then you are doing the best you can. This means follow your ABCDE and treat as you find. It is important that you approach any sick person in the same way and adopt an ABCDE approach. There are various signs to look for and it is important to consider these as part of your ABCDE assessment.
There is no universally agreed definition which hints as the diversity of symptoms. The Resuscitation Council (UK) quote the definition from The European Academy of Allergology and Clinical Immunology Nomenclature Committee, which is:-
Anaphylaxis is a severe, life-threatening, generalised or systemic hypersensitivity reaction.
This is characterised by rapidly developing life-threatening airway and/or breathing and/or circulation problems usually associated with skin and mucosal changes.
The Resuscitation Council (UK) goes on to say that anaphylaxis is likely when all 3 of the following criteria are met:-
- Sudden onset and rapid progression of symptoms
- Life-threatening Airway and/or Breathing and/or Circulation problems
- Skin and/or mucosal changes (flushing, urticaria, angioedema)
So what are the life threatening signs?
The first thing to consider is speed of onset, most reactions usually occur within several minutes. If from injection of medication reactions typically occur within twenty minutes. If from food or orally ingested medicines then it may take slightly longer. When looking at the person they will feel and look unwell, they may have a ‘sense of impending doom’ and feel anxious.
It is important that you complete your ABCDE assessment and identify any of the following problems:-
Airway signs
- Swelling of the airways
- Hoarse voice
- Stridor – a high-pitched noise as the person breathes in
Breathing signs
- Shortness of breath – increased respiratory rate
- Wheeze
- Patient becoming tired
- Confusion caused by low levels of oxygen in the blood
- Cyanosis (appears blue) – this is usually a late sign
- Respiratory arrest – breathing stops
Circulation signs
- Clammy
- Increased pulse rate (tachycardia)
- Low blood pressure (hypotension)
- Feeling faint (dizziness)
- Collapse
- Decreased conscious level or loss of consciousness
- Anaphylaxis can cause angina type symptoms eg myocardial ischaemia and electrocardiograph (ECG) changes even in individuals with normal coronary arteries.
- Cardiac arrest – breathing and heart stops
Disability signs
- Confusion
- Agitation
- Loss of consciousness
Exposure signs
- 80% have skin or mucosal changes, for example rashes or hives
- 20% may have subtle or no skin or mucosal changes
Treatment and management
The first line treatment for anaphylaxis is intramuscular (IM) adrenaline. Your location may alter what is available to you in terms of equipment and expertise. This may vary between being on the street with someone, at work or in a health care setting where there are staff available who are trained and competent at administering an IM injection.
If all that is available is an auto-injector then it is appropriate to use it. It is also important to remember that the administration of adrenaline for life threatening anaphylaxis and with the purpose to save a life does not require a prescription. Any suitably trained lay person is able to administer adrenaline. Under the Medicines Act 1968 if you are able to recognise anaphylaxis and working within the guidelines of any appropriate registering body you are not committing an unlawful act. Essentially you do not need to be a health care professional to use an auto-injector. You can find more information in FAQs on anaphylaxis from the Resuscitation Council (UK).
Always ensure your emergency help is on the way. Any person who suffers anaphylaxis should be transferred to A&E as an emergency.
Anaphylaxis can be difficult to diagnose and I therefore always discuss anaphylaxis within my medical emergency course to allow learners to ask and clarify questions. It is also possible to have additional training on anaphylaxis. If you would like more details please contact me.
If you have any questions or comments please contact me.
Regards,
Helen Watson
Orchard Training Services
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