Published - Thu, 11 Aug 2022

EVALUATION AND TREATMENT OF ANAPHYLAXIS

EVALUATION AND TREATMENT OF ANAPHYLAXIS

For making the diagnosis and determining the intensity of the reaction to formulate the management strategy, the history and physical examination are essential.


1. Patient history

a) The cause of the anaphylaxis should be determined.

Antibiotics including penicillin are a major source of negative medication responses. The majority of responses happen after parenteral administration as opposed to oral.

Radiocontrast media cause anaphylactoid reactions at a rate of 0.22% for ionic (high osmolar) agents. The risk of death has been estimated to be 1 in 10,000 (0.01%). Nonionic (low osmolar) agents cause anaphylactoid reactions at a rate of 0.04%.

Lidocaine and other local anesthetics rarely cause true allergic reactions, but many patients report “allergy to ‘caines’” because a variety of nonallergic reactions are associated with its administration.

b) The route and timing of exposure should be ascertained. The route may be by injection, ingestion, inhalation, or cutaneous absorption.

c) Other details that may be crucial for the evaluation and management of the case include previous reactions to the same substance and the severity of those reactions, underlying medical conditions like cardiovascular disease or pulmonary disease, current medications like beta-blockers, antihistamines, and corticosteroids, as well as medication allergies.


2. Laboratory testing (see Table)


DIFFERENTIAL DIAGNOSES OF ANAPHYLAXIS 

Asthma exacerbationHypovolemic shock or sepsis
Carcinoid syndromeMastocytosis
Cerebrovascular accident Myocardial infarction
Drug intoxicationPulmonary embolus 
Hereditary angioedemaSeizure disorder
HyperventilationUrticarial syndrome
HypoglycemiaVasovagal syncope 
Laryngeal foreign bodyTrauma to larynx


3. Radiography: A chest radiograph may reveal hyperinflation or atelectasis.


THERAPY

1. Prompt intervention is vital: 

a) Antigen exposure needs to be stopped, and vital signs need to be watched. At the first sign of the reaction, any intravenous antigen infusion should have been discontinued, and any topical medications should have been removed. Gastric lavage should be taken into consideration if the agent was recently consumed. 

b) Epinephrine is administered to prevent mediator release. It relaxes laryngeal and bronchial smooth muscle and supports blood pressure.

i) Side effects: Epinephrine may cause vomiting, hypertension, tremor, and tachydysrhythmia.

ii) Possible contraindications include cardiac ischemia, severe hypertension, and pregnancy. Glucagon can be substituted if epinephrine is contraindicated.

iii) Dosage and administration

Epinephrine 0.1% (1:1,000 preparation). In patients with stable vital signs, epinephrine 0.1% is given subcutaneously or intramuscularly every 15 minutes as required. The dosage is 0.3 to 0.5 mL for adults and 0.01 mg/kg for children.

Epinephrine 0.01% (1:10,000 preparation) is administered intravenously when there is significant airway compromise or shock. For adults, the dosage is 1 to 3 mL, administered slowly intravenously (or diluted in normal saline to 10 mL and administered via an endotracheal tube). Children receive 0.1 mg/kg by slow intravenous infusion.

c) Stabilization of airway, breathing, and circulation (ABCs)

i) The airway should be observed closely and supported as needed with endotracheal intubation or cricothyrotomy.

ii) High-flow oxygen should be administered.

iii) Blood pressure should be supported by placing the patient in a recumbent position, infusing intravenous fluids, and, if necessary, administering a continuous infusion of epinephrine.

d) Treatment of bronchospasm is with Beta agonists or nebulized epinephrine

e) Histamine receptor blockade

i) Histamine-1 receptors should be blocked with an antihistamine such as diphenhydramine (1 to 2 mg/kg intravenously, up to a total dose of 50 mg, initially and every 6 to 8 hours as needed, for adults and children).

ii) Histamine-2 receptors. Blocking the histamine-2 receptors with an agent such as cimetidine or ranitidine may also be advantageous.

f) Prevention of late-phase reactions: A corticosteroid (e.g., prednisolone, 1 to 2 mg/kg intravenously every 6 hours until conversion to oral medication) should be administered intravenously in an attempt to abort late-phase reactions.

g) Treatment of refractory anaphylaxis: In the presence of β- blockade, anaphylaxis may be particularly refractory to treatment, and glucagon (0.05 mg/kg administered as an intravenous bolus, followed by an infusion at a rate of 0.07 mg/kg/hour) may need to be employed.


2. Late-phase reactions may occur in the ensuing 6 to 48 hours. The treatment strategy for a late-phase reaction is the same as that for an initial reaction.

Created by

Rigomo Team

Rigomo is a leading online education platform that offers a wide range of courses to help individuals enhance their skills and achieve their career goals. With our user-friendly interface and expert instructors, we strive to provide high-quality education to everyone, anytime and anywhere. Join us today and take the first step towards a brighter future.

Rigomo is an e-learning platform that was founded in 2019 by a team of dedicated professionals with a passion for revolutionizing the way people learn. The platform offers a range of online courses that cover various industries, including business, technology, healthcare, and more.

Rigomo's courses are designed to be interactive and engaging, with a focus on practical skills that learners can apply in their careers. The platform uses a combination of video lectures, quizzes, and hands-on projects to help learners master the subject matter.

Rigomo is committed to providing affordable and accessible education to people around the world. The platform offers a range of pricing options, including monthly and annual subscriptions, as well as pay-as-you-go options for individual courses.

Since its launch, Rigomo has received numerous accolades for its innovative approach to e-learning. The platform has helped thousands of learners across the globe acquire new skills and advance their careers.

As Rigomo continues to grow, the team remains committed to providing high-quality education that is accessible to all. The platform is constantly updating its courses and features to ensure that learners have access to the latest tools and technologies.

View profile

Comments (0)

Search
Popular categories
Latest blogs
Transforming Emergency Care: The Story Behind Rigomo's Revolutionary PPMMP Course
Transforming Emergency Care: The Story Behind Rigomo's Revolutionary PPMMP Course
In the bustling corridors of a major hospital in Mumbai, Dr. Ayesha Khan felt the pulse of emergency medicine beating at a frantic pace. As a seasoned emergency room physician, she had seen it all — from the heartbreaking to the miraculous. Yet, despite her years of experience, Dr. Khan often felt that something was missing — a gap between the theoretical knowledge she had acquired and the real-world application of managing complex patient scenarios. It was during one critical incident, a complicated case of a diabetic emergency with multiple complications, that the idea for a comprehensive training program began to take shape.Dr. Khan observed that while her team was highly educated, they often hesitated, unsure of the best course of action when standard procedures didn’t align perfectly with the complexities presented by real-life cases. This observation was the seed that grew into the Practical Patient Management Program (PPMMP), developed in collaboration with Rigomo, a pioneer in healthcare education.The Genesis of PPMMPThe journey began with a simple question: How could healthcare professionals bridge the gap between theoretical learning and practical execution? The answer lay in creating a dynamic, interactive, and comprehensive training environment that mirrored real-life medical emergencies more closely than traditional classrooms or online courses ever could.Dr. Khan approached Rigomo with her vision, and together, they crafted a curriculum that was deeply rooted in the realities of medical practice. They decided to focus on a multi-faceted approach, incorporating simulations of emergency scenarios, step-by-step analytical techniques, and patient management strategies under pressure.What Sets PPMMP Apart?From the outset, the PPMMP was designed to be different. It wasn’t just about learning what to do; it was about understanding why, how, and when to do it. The course covers a wide range of emergencies — from metabolic crises like diabetes to respiratory emergencies and anaphylaxis. Each module is built around the latest research and clinical guidelines, ensuring that participants receive the most up-to-date information possible.However, the real magic of the PPMMP lies in its delivery. Recognizing the linguistic diversity of India, the entire course is offered in Hindi, making it accessible to a broader range of healthcare professionals. This decision has democratized access to advanced medical training, particularly benefiting those in rural or underserved areas.A Real-World ImpactOne of the most compelling testimonials comes from Dr. Manav Arora, a young doctor who enrolled in the PPMMP shortly after its launch. During an overnight shift, Dr. Arora faced a severe case of pulmonary embolism — a situation he had only read about in textbooks. Armed with knowledge and hands-on practice from the PPMMP, he was able to lead his team effectively, administer the right interventions, and save a life that night. Dr. Arora credits the PPMMP for his confidence and quick decision-making skills.Looking AheadToday, the PPMMP is not just a course but a movement. It’s about empowering doctors, nurses, and paramedics with the confidence to take bold, informed actions in critical situations. As healthcare continues to evolve, Rigomo is committed to updating the curriculum to include new findings, techniques, and technologies.The success story of the PPMMP is a testament to the power of innovative thinking in education and the profound impact it can have on healthcare delivery. It stands as a beacon for future endeavors in medical training, highlighting the crucial link between knowledge and action in saving lives.The Practical Patient Management Program has grown significantly since its inception, touching the lives of numerous healthcare professionals across India. The course’s success has encouraged other institutions to look towards similar models of integrated, practical training programs. To learn more about the PPMMP or to enroll in this transformative course, please visit PPMMP at Rigomo https://ppmp.rigomo.com. By joining this program, you not only gain access to advanced medical training but also become part of a community dedicated to excellence in healthcare services. The platform’s easy-to-navigate interface and comprehensive resources ensure that every participant can maximize their learning potential and truly make a difference in their professional environments.

Sun, 12 May 2024

Empowering Rural Healthcare: How Pogiko's AI is Bridging the Gap in Medical Services
Empowering Rural Healthcare: How Pogiko's AI is Bridging the Gap in Medical Services
Access to quality healthcare remains a significant challenge in rural regions, where the scarcity of medical resources and professionals exacerbates health disparities. Pogiko, an innovative AI-powered tool from Rigomo Technologies, is emerging as a transformative solution to these challenges. This article delves deeper into how Pogiko is enhancing healthcare delivery in underserved areas.Technological Innovation Meets Rural Medicine Pogiko utilizes advanced AI algorithms to perform functions like disease diagnosis, medical report analysis, and case management, traditionally reserved for specialists in well-equipped urban centers. By automating these complex tasks, Pogiko provides rural doctors with the capabilities of a virtual specialist team, enabling them to offer comprehensive medical care even in resource-limited settings.Immediate Benefits of AI in Rural HealthcareEnhanced Diagnostic Accuracy: Pogiko's AI quickly interprets symptoms and medical data, providing accurate diagnostics that are crucial in areas where specialist consultation is rare or delayed.Decision Support: It offers real-time decision support to healthcare providers, aiding them in treatment planning and management, thus minimizing the risks associated with delayed care.Education and Training: Through regular updates and learning tools, Pogiko keeps rural healthcare providers abreast of the latest medical advancements and treatment protocols, significantly improving their knowledge base without the need for frequent travel for training.Case Management and Remote Assistance With Pogiko, rural healthcare practitioners can manage multiple cases efficiently, with AI suggesting the most effective treatment plans based on the latest guidelines and patient data. Additionally, its ability to facilitate remote consultations helps bridge the distance between rural practitioners and specialists in urban centers, fostering a collaborative approach to patient care.Long-Term Impact and Scalability The scalability of AI tools like Pogiko promises a broader reach, potentially transforming healthcare delivery in remote areas globally. By providing high-quality medical advice and support, Pogiko helps reduce healthcare inequalities, ensuring that rural populations have better health outcomes and access to advanced care practices.Pogiko exemplifies how AI can play a pivotal role in not just supporting but significantly enhancing healthcare in rural areas. As technology advances, the potential for AI to serve as a cornerstone in rural healthcare systems becomes increasingly evident, offering a beacon of hope for regions still struggling with the basics of medical care.

Thu, 25 Apr 2024

Advancements in the Treatment of Pulmonary Embolism: What's New in 2024?
Advancements in the Treatment of Pulmonary Embolism: What's New in 2024?
Artificial Intelligence in DiagnosisAdvancements in Endovascular TherapiesPersonalized Treatment ApproachesNew Pharmacological TreatmentsMultidisciplinary Care TeamsThe landscape of pulmonary embolism treatment in 2024 is characterized by rapid advancements in technology, personalized medical approaches, and the development of safer, more effective therapies. These innovations not only improve the quality of care received by patients but also significantly increase survival rates and enhance the quality of life following a PE diagnosis. As research continues and technologies evolve, we can expect even more impressive strides in the treatment of this challenging condition.

Wed, 24 Apr 2024

All blogs