Anaphylaxis

Anaphylaxis

25 yr old female is red called to resus after developing difficulty in breathing. Her symptoms started soon after a meal at a local restaurant. There is no PMhx. Swollen lips and eyes, hoarse voice, wheezy chest.
— No PMhx
 Initial examination

Initial examination

Physiology

A – Able to talk with hoarse voice, mild drooling

B – Rate 25, SpO2 91%.

C – Pulse 120, BP 90/65. 

D – E4 V5 M6 pupils equal

E – Temp 35.9°C

Clinical Findings

  • Hoarse voice, mild drooling

  • B/l chest wheezes


Why We Simulated

“Available UK estimates suggest that approximately 1 in 1333 of the population of England has experienced anaphylaxis at some point in their lives. There are approximately 20 deaths from anaphylaxis reported each year in the UK, with around half the deaths being iatrogenic.

Anaphylaxis may not be recorded, or may be misdiagnosed as something else, for example, asthma."

NICE guideline


Learning Points

  1. Use of adrenaline should be two IM doses – unless by a clinician experienced in using IV doses.

  2. Remember to clarify the strength/dose of adrenaline required

  3. Emergency Drugs are kept in the top draw of all trollies in Resus and are there to be used!

  4. Team members to verbalise clearly if they are unable to complete an assigned task.

  5. The difficult airway trolley is separate to the standard airway trolley and contains different equipment

Positive Feedback

  • Pre-alert time used to assign roles.

  • Early diagnosis of anaphylaxis made and administration of two doses of adrenaline.

  • Additional therapies such as steroids were considered

  • Clear verbalisation of a plan in the event of further deterioration

Difficult Airway trolley

Standard Airway trolley

Edit & Peer Review by Jamie Sillett
Lightning Learning: Head Injury

Lightning Learning: Head Injury

Asthma

Asthma