Third series for Resuscitation in difficult situations.

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
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3. AGENDA
 Introduction
 What is Anaphylaxis
 Causes of Anaphylaxis
 Epidemiology
 Management of Cardiac arrest in Anaphylaxis
 Supportive Management for Anaphylaxis
 Conclusion
 References
 Q&A
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4. INTRODUCTION
 Various difficult situations may arise that lead to
cardiac arrest.
 The skill of bystanders is paramount for outcome
of survival.[1]
 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.[2]
 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.[3]
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 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]
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 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]
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 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]
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 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]
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 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]
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 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]
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 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.
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 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.
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 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
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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