Update on anaphylaxis based on this fresh guideline from the the Anaphylaxis Working Group of the Resuscitation Council UK (RCUK)(#1/7).
resuscitationjournal.com
resuscitationjournal.com
no RCT-level data on epinephrine, so recs based on retrospective data & opinions. they recommend IM administration in most settings due to ease of use & familiarity. epinephrine gtt can be used by clinicians experienced & familiar with this route, with titration to effect.(#2/)
the recommended dose of IM epinephrine in adults is 0.5 mg. additional doses may be given q5minutes if symptoms are refractory. if three cumulative doses don't work, then consider starting an IV infusion.(#3/7)
antihistamines get thrown under the bus. the key here is that initial therapy should focus on epinephrine, fluid resuscitation, and airway management. antihistamines are a 2nd/3rd line therapy which may be added later for urticaria, but shouldn't delay critical interventions.
steroid gets thrown under the bus too. steroid is unnecessary if anaphylaxis responds well to IM epinephrine. consider steroid in refractory cases or anaphylaxis/asthma overlap situations (this would likely include most cases severe enough to require ICU admission)(#5/7)
fresh summary box on anaphylaxis treatment! the key interventions are epinephrine, volume resuscitation, and airway management. other treatments are largely *distractors* - but OK as long as the basics are already attended to (#6/7)
how long do patients need to stay? data isn't terrific. guidelines propose the following as a general framework. don't @ me. for more on anaphylaxis see the IBCC chapter (#7/7) emcrit.org
Loading suggestions...