Anaphylaxis: pearls

25 Mar

Some highlights from a good article by Dr. James Roberts over at EM News:

 

FINDINGS IN ANAPHYLAXIS (many are probably less than you thought):

  • generalized erythema 66%
  • pruritis 56%
  • urticaria 50%
  • dyspnea 43%
  • angioedema 40%
  • wheeze 35%
  • laryngeal edema 25%
  • bronchospasm 18%
  • syncope/dizziness 15%
  • BP <90 mmHg 9%

 

good evidence for epinephrine in anaphylaxis

IM better than SC; “important to avoid the use of IV epi in all but the most egregious cases” (if you do go IV, 1:10,000 concentration, and slowly–60-90 sec diluted in saline)

“no report of problems or worse outcome when epinephrine was used…in patients with cardiac history” (anaphylaxis is bad anyways)

not much evidence for pre-medication with glucocorticoids or H1/H2-blockers preventing anaphylactoid reactions to contrast media (“Such premedication will likely persist.”)

for anaphylaxis treatment, “I see no downside to giving glucocorticoids or antihistamines…but the first drug chosen should always be epinephrine.”

reminder: standard dose is 0.3mg (1:1000 concentration) IM

 

References: EMN article; picture

 

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