You’re working as a solo responder and have been called to a 27-year-old female with sudden onset, severe difficulty in breathing. Control have passed on that the patient is at work, there is a first aider present, and it is reported that the patient has an allergy to peanuts. An Ambulance is 10 minutes behind you.
On arrival, the patient has been taken to a small first aid room, the first aider hands over that she knows the patient and she has a severe allergy to peanuts. She started to deteriorate shortly after lunch. The patient has her own EpiPen’s and has administered one to herself on initial symptoms starting. Looking at the patient, she has angioedema around the lips, significantly increased work of breathing, sounds audibly wheezy, looks slightly pale, and is very anxious.
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What are the first steps you complete after your initial impression and handover from the first aider?
In the Ambulance context, what route can you give the adrenaline 1:1000 bolus in suspected anaphylaxis?
The first aider states the patients’ EpiPens are available nearby. Would you like the first aider to administer the patient’s own EpiPen or do you administer your own IM adrenaline?
You start thinking about next steps, what would you further consider in the Anaphylaxis management? (tick all that apply)
The patients’ symptoms slightly improve but there is still evidence of angioedema and wheezing. How long after the first adrenaline 1:1000 can you give a second dose?
Is angioedema always associated with suspected anaphylaxis?
What skin and/or mucosal changes are you looking for when assessing for anaphylaxis? (tick all that apply)
Is myocardial ischemia during anaphylaxis a potential symptom requiring ECG monitoring when appropriate?
Within Ambulance guidelines, what are the recommended dosages required for any fluid therapy associated with haemodynamic compromise through anaphylaxis?
According to some guidelines, if a severe anaphylaxis reaction has occurred, what is the average time where a patient may arrest after ingestion of a food allergen? (Highlighting the need for prompt administration of adrenaline)
The patients’ condition significantly improves, following a second adrenaline 1:1000 administration, oxygen via high flow mask, and IV fluid management. Her observations and symptoms completely ease, and she starts to calm. Your back up Ambulance arrives. After discussions with the patient, she explains she would prefer to go home as this has happened before and she feels a lot better. Do you accommodate her request or persuade her to go into hospital regardless of a quick recovery?
How long does the NICE guidelines recommended an adult patient be appropriately observed for after a suspected anaphylactic reaction? (This may vary due to severity and speed of treatment)
What is the defining feature of refractory anaphylaxis?
The definition of a biphasic reaction is after the full recovery of anaphylaxis, a reoccurrence of symptoms occur within 72 hours with no further exposure to the allergen?
The patient agrees to attend hospital and you get her settled in the back of the Ambulance. With symptoms completely gone, is it still recommended that adrenaline 1:1000 continues to be given every 5 minutes?