Anaphylaxis Independent Learning Package

Transcription

1 Anaphylaxis Independent Learning Package

2 What is Anaphyalxis? Anaphylaxis is a very severe allergic reaction, usually to a substance to which an individual has previously shown sensitivity. It is for this reason that documentation of the nature of previous reactions is important as those showing signs such as rashes in the past are at significantly higher risk of developing anaphylaxis on future contact with the same allergen. What Causes Anaphylaxis? There are a number of allergens that can cause anaphylaxis. Common allergens are foods such as nuts, eggs and shellfish and also other substances such as drugs and latex. You should also document food allergies as certain medications also contain food products; for example, a widely used anesthetic drug contains eggs. What Are the Features of Anaphylaxis? During the reaction the immune system mounts a repose to the allergen causing the release of a number of chemicals including histamine. This causes: Swelling of the tissues this often occurs around this tissues of the face, most notably the lips, tongue and around the eyes. This swelling is also referred to as angioedema. The mucosa inside the mouth and throat can also swell. This may not be visible but any difficulties in swallowing or speaking or any change in the natures of the voice should cause immediate concern for the safety of the airway. Constriction of the airways this causes difficulty breathing and often a wheeze Profound dilatation of the blood vessels this causes a catastrophic drop in blood pressure Rash this may be noted on the trunk and/or limbs as well as the face and neck. This is referred to as an urticarial rash and is often descried as resembling hives or nettle rash How Will I recognize Anaphylaxis?

3 The most reliable way to detect the clinical signs of anaphylaxis is to undertake a rapid but focused assessment of the patient using the ABCDE approach. Airway There may be swelling of the tips and tongue There may be changes in the nature of the voice or the patient may complain of difficulty speaking or swallowing Oxygen should be applied at 15 litres per minute using a nonrebreathe mask while you continue your assessment Breathing The respiratory rate is usually raised Oxygen saturations may be normal initially but may start to fall as the airway and breathing are increasingly affected There may be a wheeze caused by bronchoconstriction There is likely to be increased work of breathing reflected in the use of the accessory muscles Circulation There may be a tachycardia. Bradycardia is a late sign and reflect impending cardiac arrest. Blood pressure is likely to be low Capillary refill will be delayed Disability The patient will be alert but anxious initially. There will be no change in pupil size Blood glucose will be normal in most cases but may be slightly elevated as part of the stress response Drug history is vitally important in establishing a likely allergen Exposure There is likely to be evidence of an urticarial rash and there may be generalized flushing of the skin caused by peripheral vasodilation What is the Treatment for Anaphylaxis? The first line emergency treatment for anaphylaxis is an intramuscular injection of adrenaline. Adrenaline constricts the peripheral blood vessels increasing blood pressure and also causes bronchodilation reducing wheeze and work of breathing. This is given using an auto-injector device where possible, either using a device carried by the patient or by using an Emerade auto-injector device supplied by the Trust.

4 The recognized doses of adrenaline are as follows: Adult and Child over 12 years: 500mcg Child 6-12 years: 300mcg Child under 6 years: 150mcg The injection should be given ion the outer aspect of the thigh halfway between the hip and the knee. You can inject through clothing and should not delay treatment by undressing the patient. Secondary treatment with steroids and anti-histamine is required in a hospital setting. What do I do After Administering the Adrenaline? After you have administered the dose of adrenaline you should reassess the patient using the ABCDE approach. If there is no effect or only a partial improvement a further dose can be repeated in the other leg five to ten minutes after the first dose. You should ensure that emergency help is on its way. Stay with and reassure the patient while waiting for the emergency services. You should report the incident using the Trust Incident Reporting system and should also clearly document the events in the patient s notes. Any computer records should be flagged to notify other health professionals of the reaction where this is possible. Assessment criteria for use of the Emerade Auto-Injector Device. Name of Practitioner: Ward or Department:

5 Information Regarding the Emerade Auto-Injector Device This assessment process should be read in conjunction with the product video More information can be found here: Assessment criteria: 1. Confirm the diagnosis of anaphylaxis using the ABCDE framework to assess a patient 2. Request necessary emergency equipment and for a call to be made to the emergency services 3. Correctly prepare the 150 / 300 / 500 Emerade device ensuring that this is within the manufacturer expiry date 4. If possible both gains verbal consent from the patient positions the patient for the injection procedure 5. Identifies an appropriate site for the IM injection (Thigh/Deltoid) 6. Demonstrate administration using a Emerade training device 7. Describe correct disposal of the used device (Sharps safe) 8. Reassess the patient using the ABCDE assessment framework 9. Explain the rationale for administration of a subsequent dose of adrenaline 10. Describe appropriate documentation of the intervention 11. Provide handover to the emergency services using the SBAR handover methodology I confirm that I have assessed of the practitioner in the use of the Emerade Auto-Injector device: Name of Assessor: Signature: Date: I confirm that I have achieved competence in the use of the Emerade Auto-Injector device: Name of Practitioner: Signature: Date: