Anaphylaxis during Anaesthesia Immediate Management IF Adult CARDIAC ARREST Pulseless Electrical Activity, PEA Danger and Diagnosis Peetu Reed i} Peery ere ee Ee pac aoste een ry Laeger Poel Ree yt) Ree eee cl ere ait eV ae + ALS GUIDELINES for non-shockable rhythms ‘+ 1mg LV. Adrenaline, Repeat 1 -2minutely pn + Immediately start GPR. Elevate legs. 2 L Crystalloid = Unresponsive hypotension or bronchospasm + Remove triggers e.g. chlorhexidine, synthetic colloid + Stop procedure. Use minimal volatie if GA * Call for Help and Anaphytaxis box + Assign a designated Leader and Scribe + Assign a Reader of the cards * Consider early intubation: airway oedema ‘= Confirm FiO, 100% + if hypotensive: Elevate legs * Bolus 21. Crystallaid, Repeat as needed + Large bore LV. access, Warm 1. fluids if possible er eR gee ete TF Beto Tree cr ae eet cic enerEe een at Ue ct) Immediate Management a IF Paediatric CARDIAC ARREST Pe dea eee a a Dee feoseret rca) Bede | Rerreker ia) Pe eae Ente ton ay Reeds ty ea rtd feet ena eee foes | DeTitta Paediatric Adrenaline Infusion Crue Tacuba trey Cece tere + ALS GUIDELINES for non-shockable rhythms + 0.1 mL/kg of 1:10,000 (10 mg/kg) LN. Adrenaline + Repeat 1-4 minutaly pm, + Immediately start CPR. 20 mLikg Crystalioia + Unresponsive hypotension or bronchospasm + Remove triggers e.g, chlorhexidine, synthetic colloid + Stop procedure. Use minimal volatie GA * Callfor Help and Anaphylaxis box + Assign a designated Leader and Scribe + Assign a Reader of this card + intubate early: arway oedema + If hypotensive: Elevate legs + Bolus 20 mL/kg Crystalloid, Repeat as needed + Large bore IV; Access, Warm LV. fluids if possible ‘mg Adrenaline in 50 ml. (20 meg/mL) Commence at 0.3 mL/kg/hr ona nit TEcreenG Rok, IF NOT RESPONDING see ‘Paediatric Refractory Management’ey Pd Refracto Managemen Request more help Triggers removed? Resistant Hypotension Bere eer ae Sy rere MRM eee On 0) Behe Serer ono Sree ese en ead Sea ice] ie ite eT Beret mae Seren Se ete Serena) See eo} Dee ieee end ered et iol Melina lee ei) * Consider ealing arrest code * May require assistance with fluid resuscitation * Chlorhexidine including impregnated CVCs + Synthetic Colloid disconnect and remove + Latex remove from OR * Consider Arterial tine * Consider TORTTE Adult Recommendations Noracirenaline infusion 3 ~ 40 mogimin (0.05 -0.5 meg/kg/min) andor ‘Vasopressin bolus t- 2 units then 2 units per hour I neither available use oither ‘Metaraminol or Phenylephrine infusion ‘Glucagon 1-2 mg LV. every $ min unt response Draw up and administer IV. (Counteract blockers) Adult Recommendations Salbutamol + Metered Dose Inhaler 12 puts (1200 meg) bolus 100-200meg +/- infusion 5-26megimin Magnesium 2g (8 mmol) over 20 minutes ‘Consider inhalational Anaesthetics and Ketamine + Manual Left Uterine Displacement * Caesarean within 4 minutes if amest or pert-arrest ‘See ‘Differential Diagnosis Card’ in Anaphylaxis BoxPee Pu eo Refractory Management Cee ett) : poe ogee ae service * Chlorhexidine inciucing impregnated CVCs Triggers removed? + Synthetic Colloid disconnect and remove + Latex remove trom OR + Consider Arterial tine = Consider TOE/TTE Paediatric Recommendations 5 Noradrenaline infusion 0.1 -2 meg/kg/min ee Uday sta ciel) 0.15 mgikg in 50 mL runat 2 - 40 mL/hr rent ate eee eatery andor Brean TNA sete ee oT EL} ‘Vasopressin Infusion 0.02 - 0.06 units/kcg/tr yee ess eee dunt som * Consider CVC 2 mb bolus then 1-3 mL/hr Glueagon 40 megikg LV. to max 1mg Paediatric Recommendations Salbutamot ; + Metered Dose Inhaler (100 meg/puff) Resistant Bronchospasm 6 puffs <6 yoars, 12 puffs > 6 years erty iene war) og 4 aon —— aE etre ser cel pemieans pect eT iced Magnesium sulfate 50% (500 mg/mL) Tension pneumothorax (decompress) 50 mgkka to max 2.g aver 20 minutes OCP our ition cd ip ceredahi ne mie Betis ia ‘Aminophylline 10 ma/kg over 1 hour (max500 mg) Hydrocortisone 2- 4 mglkg (max 200mg) Consider other diagnoses SO et maa SLOnce Situation is St ed Dexamethasone 0.1-0.4mgikg (Paediatric maximum 12 mg) Hydrocortisone 2-4 maka (Paediatric maximum 200 mg) Consider Steroids Consider Oral non-sedating Antihistamines Consider ORAL Antihistamines when patient able to take oral medications LV/LM. Antihistamines NOT RECOMMENDED Consider: Proceed/Cancel/Postpone Surgery Postoperative ICU/HDU monitoring + Trypiase at 1 hour, 4 hours and > 24 hours ‘Send to laboratory for processing ASAP f>11 hour to laboratory then refrigerate Use serum (SST) or plain tube + Other investigations as clinically indicated + Coagulation screen if proceeding with surgery * Monitor closely for 6 hours = Consider 24 hours ICU/HDU if moderate to severe * Anaphylaxis may persist for >24 hours despite aggressive treatment Letter with Patient: Reaction Description + Agents Used Refer Patient for Testing and Allergy Assessment For referral form & to locate nearest testing centre go to www.anzaag.comDifferential Diagnosis Card Cardiac Arrest High Airway Pressure! Airway Compromise Skin and Mucosa Hives, fushing exythema, Urteara,shling head'and neck or peripheries ‘Dyspnoea, wheeze, stridor, cificuy inflating lungs ‘Circuit matfunction —»- Check using Sol inflating Bag “ Misplacediinked Airway device» Check with suction catheter|Consider changing device ‘Tension pneumothorax» Decomaress + Exacorbation of Asthma —» Treat as per Fsfractory Management + Foreign Body —» Consider bronchoscopy: + Acid aspiration = Consider bronchoscopy ‘Hypovolaemia = Sepsis = Drug everdase + Vasodiation by drugs = Neuravial blockade ‘+ Embolism: Thrombotic, lr or Amniotic += Vasovagal = Direct Histamine Release + Cl-esterase deficiency (angioedema only) Mastocytosis: += Cold induced anaphylanis eee oie ue ie eeu eucaa inl MD eee eine cc) Mild (Grade 1) Moderate (Grade 2) Life Threatening (Grade 3) (Generalised mucocutaneous signe: Erythema, Urticaria +/-Angiosema Moderate - Mut-organ manitestation may include: * Hypotension, tachyeardia + Evidence of bronchaspasm, cough, cificult entiation + Mucoculaneous signs Lite Threatening and requiring immediate and specific twatment: + Severe hypotension + Bradycardia or tachycardia, arrhythmias + Severe bronchospasm, andjer away oedema * Cutaneous signs may be absent, or present only after comection of hypotension Cardiopulmonary Arrest