Biphasic Anaphylaxis

 

Biphasic anaphylaxis is an anaphylactic episode followed by an asymptomatic period with the return of anaphylactic symptoms in the absence of further exposure to the triggering antigen. The incidence of secondary reaction following primary anaphylactic reaction can range from 1% to 23% and occurs in up to 23% of adults and up to 11% of children. The time interval from primary to secondary reaction ranges from 1 to 72 hours, though predominantly occurs within 8 hours of the primary event.

 

Did you know Adrenaline doesn’t work for Cardiac Arrest?

Adrenaline may improve return of spontaneous circulation, but it does not improve survival to discharge or neurologic outcome. The timing of epinephrine may affect patient outcome, but Basic Life Support measures are the most important aspect of resuscitation and patient survival.

 

Anaphylaxis

Anaphylaxis is a sudden, severe allergic reaction that may cause death. The single most effective treatment for an episode of anaphylaxis is administration of epinephrine. Epinephrine is a chemical that arrests the chain of reactions that causes the signs and symptoms of anaphylaxis.

 

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Does adrenaline need a central line?

iv-adrenalineIt has been dogmatically believed that prolonged infusion of any vasopressor mandates placement of a central line.  However, available evidence doesn’t support this. Diluted solutions of epinephrine and norephrine are safe for infusion via a well funcioning 18-20G IV proximal to the wrist.

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Adrenaline: It’s just a suggestion

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Epinephrine and other ACLS drugs lead to more patients with ROSC but no increase in the number of patients with good neurologic outcomes after OHCA.

Something that’s very interesting is the actual 2015 ACLS recommendation for epinephrine. It reads, “it is reasonable to consider administering a 1 mg dose of IV/IO epinephrine every 3 to 5 minutes during adult cardiac arrest.” This actually leaves room to not give the medication if the physician thinks it should be withheld.

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Anaphylaxis

Epipen

In Anaphylaxis, IM Adrenaline (lateral thigh) is preferred over subcutaneous injection because it leads to a more rapid rise in plasma concentration. Only use IV if the patient has circulatory collapse – this can be done peripherally for a short time period if necessary…