Published on October 13, 2014
1. RESUSCITATION TECHNIQUES IN ANAPHYLAXIS B Y A N U G O M E M E K A M B B C H , M P H , M S C O C C M E D , I G C N E B O S H
2. WELCOME & INTRODUCTIONS Logistics Emergency exits Restrooms 2
3. AGENDA Introduction What is Anaphylaxis Causes of Anaphylaxis Epidemiology Management of Cardiac arrest in Anaphylaxis Supportive Management for Anaphylaxis Conclusion References Q&A 3
4. INTRODUCTION Various difficult situations may arise that lead to cardiac arrest. The skill of bystanders is paramount for outcome of survival. Resuscitation will need to be modified in these situations depending on their peculiarities and reversible causes. Early recognition and proper management of Airway Breathing Circulation Disability and Exposure (ABCDE) is very important for survival. Image: ht tp: / /www.bygeorgejournal .ca/?p=3077 4
5. INTRODUCTION This presentation is a review based on 2010 Guidelines by American Heart Association and European Resuscitation Council. Prior Knowledge of current BLS/ACLS guidelines or resuscitation is assumed. Image: http://en.wikipedia.org/wiki/Mast_cell 5
6. WHAT IS ANAPHYLAXIS? A Multi-systemic life-threatening hypersensitivity reaction that may lead to cardiopulmonary collapse.[3,4] Commonly misdiagnosed especially if it is not life-threatening. 6 Image 1: http://jef f reyster lingmd.com/ tag/anaphylaxis / Image 2: ht tp: / /www.pb-coaching.com/anaphylaxis-be-aware-of-symptoms -and-emergency - t reatment /
7. CAUSES OF ANAPHYLAXIS? It is mostly idiopathic but may arise from common triggers like : - Food (especially in children) - Drugs (especially in adults) - Insect bites - Latex etc.[3,4] 7 Image: ht tp: / /www. rushdenosteopath.co.uk/news/2012/02/anaphylact ic - shock-act -quickly/
8. EPIDEMIOLOGY The annual frequency of episodes is 30 to 950 cases per 100,000persons[3,4] There is a life time prevalence of 0.05 to 2%[3,4] It accounts for 50 to 100 deaths annually in the United States.[3,4] 8 Image 1: ht tp: / /www.webmd.com/al lergies/anaphylaxis -13/sl ideshow-al lergy- t r iggers Image 2: ht tp: / /en.wikipedia.org/wiki /Anaphylaxis
9. MANAGEMENT OF CARDIAC ARREST IN ANAPHYLAXIS In the event of a cardio-respiratory arrest arising from anaphylaxis, normal BLS and ACLS guidelines are to be followed.[2,3,4] There is need to monitor the following parameters for diagnosis and evaluation : - Pulse - Blood pressure - ECG - Arterial blood gases - Elecrolytes - Chest X-ray and - Mast cell tryptrase [3,4] 9 Image 1: ht tp: / /www.bygeorgejournal .ca/?p=3077 Image 2: ht tp: / /medipptx.blogspot .com/2010_08_01_archive.html
10. MANAGEMENT OF CARDIAC ARREST IN ANAPHYLAXIS Insert advanced airway early via - intubation or - cricothyroidotomy This MUST be done quickly because of risk of soft tissue swelling Ensure ventilation with Bag valve mask. Administer Epinephrine(Adrenaline) parenteral: - Intramuscular or - Intravenous (To be given by experts only).[3,4] 10 Image 1: ht tp: / /en.wikipedia.org/wiki /Tracheal_intubat ion Image 2: ht tp: / /www.mnn.com/heal th/ f i tness -wel l -being/stor ies/cardiac -ar rest - survival - improved-by- increased- resusci tat ion- t ime
11. MANAGEMENT OF CARDIAC ARREST IN ANAPHYLAXIS CPR maybe prolonged in this case. [3,4] Fluid resuscitation with isotonic crystalloids like normal saline is also important. [3,4] Administer high concentration and high flow oxygen to the patient. [3,4] Other vasoactive drugs and inotropes can also be utilized if they are non-responsive to epinephrine like: - Vasopressin - Noradrenaline etc. [3,4] 11 Image 1: ht tp: / /cache.dayl i fe.com/ imageserve/0avEbCp0A60EH/340x. jpg Image 2: ht tp: / /www.gponl ine.com/managing-anaphylaxis-dur ing-emergency/ al lergic -disorders/anaphylaxis/ar t icle/1052048
12. SUPPORTIVE MANAGEMENT FOR ANAPHYLAXIS Other supportive management that may be beneficial includes : use of Antihistamine H1 and H2 antagonists IV Corticosteroids Inhaled/IV Bronchodilators and Extracorporeal support like Cardiopulmonary bypass[3,4] 12 Image 1: ht tp: / /www.medscape.com/ features/sl ideshow/acaai2012#6 Image 2: http://www.webmd.com/al lergies/anaphylaxis -13/sl ideshow-al lergy- t r iggers
13. CONCLUSION Difficult situations may arise or lead to need for resuscitation. Modifications and consideration of reversible factors, including importance of making early decisions to - initiate resuscitation - invite expert and - manage the patient accordingly is paramount to survival in these situations. 13 Image: ht tp: / /www.gponl ine.com/managing -anaphylaxis -dur ing-emergency/ al lergic -disorders/anaphylaxis/ar t icle/1052048
14. CONCLUSION Mastery and awareness of the basic techniques and guidelines for BLS/ACLS by everyone is crucial to success in resuscitation in theses situations. Get Trained to save lives. 14 Image: ht tp: / /en.wikipedia.org/wiki /Cardiopulmonary_resusci tat ion
15. REFERENCES 1. J.R Casal Codesido, y M.J. Vazquez Lima, 2007; Out-of Hospital Cardiopulmonary Resuscitation: Where are We now? Emergencias 2007;19:295-297. 2. Australian Resuscitation Council; New Zealand Resuscitation Council, 2011; Guideline 11.10 Resuscitation in Special Circumstances: 1-14 3. Jasmeet Soar et al,2010, European Resuscitation Council Guidelines for 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma,anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution; Elsevier Ireland Ltd, Resuscitation 81(2010)1400-1433, doi:10.1016/j.resuscitation.2010.08.015 4. Terry L. Vanden Hoek et al, 2010, Cardiac Arrest in Special Situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care; Circulation.2010:122:S829-S861; doi:10.1161/CIRCULATIONAHA.110.971069; Online ISSN:1524-4539 15
16. . 16 Image:http: / /handsonblog.org/2011/01/26/eight - t ips-for-wr i t ing- the-per fect - thank-you- note/
17. QUESTIONS 17 Image: ht tp: / /www.openbkautoloans.com/wp -content /uploads/2012/04/quest ion - and-answers-bad-credi t -car- f inancing. jpg
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