Lightning Learning: Anaphylaxis

Lightning Learning: Anaphylaxis

What to consider when dealing with Anaphylaxis in the Emergency Department.
— advice is based on local guidelines & procedures


  1. Systemic IgE mediated hypersensitivity reaction

  2. Mast cell degranulation causes histamine and serotonin release

Signs and Symptoms

  • Pharyngeal oedema, tongue swelling

  • Bronchospasm and tachypnoea

  • Hypotension and tachycardia

Usually presents with skin and mucosal changes BUT NOT ALWAYS!

Treat with…

  • IM adrenaline 500mcg 1:1000

  • IV Chlorphenamine 10mg

  • IV hydrocortisone 200mg     

  • High flow O2 and fluid challenge


Consider anaphylaxis if…

Sudden onset of symptoms with skin and mucosal involvement.

If there is respiratory and/or circulatory compromise:

  • Especially if exposure to a known allergen,

  • …but always consider WITHOUT allergen exposure

5% of reactions are biphasic:

  • 2nd reaction after treatment without re-exposure to allergen

Observe patients for 6 hrs post reaction and discharge with advice and epipen.

Blood Test

Mast cell tryptase taken at 1, 6 and 24 hours post reaction. Refer to allergy clinic at discharge if allergen not known.

Lightning Learning: Spontaneous Pneumothorax

Lightning Learning: Spontaneous Pneumothorax

The End of Life Care Jigsaw

The End of Life Care Jigsaw