Primary Care Workers- Anaphylaxis

The following extracts have been taken from the Resuscitation Council UK Website, and do not constitue the full guidelines.

Emergency Treatment of Anaphylactic Reactions

"This guideline is for healthcare providers who are expected to deal with an anaphylactic reaction during their usual clinical role (e.g., doctors, nurses, paramedics) working in the hospital or out-of-hospital setting. There is considerable variation and overlap between the skills and knowledge of different healthcare providers who are expected to treat an anaphylactic reaction. We have therefore deliberately not developed guidelines for specific groups of healthcare provider.

Individuals who are involved in resuscitation regularly are more likely to have advanced resuscitation skills than those who are not. This guideline does not expect individuals to obtain intravenous access in an emergency if this is not part of their usual role. Rather, individuals should use skills that they know and use regularly. This will make it more likely that these skills are used effectively on the rare occasions when they are needed to treat an anaphylactic reaction. Any extra skills specifically for the treatment of a patient with an anaphylactic reaction should be reasonably easy to learn, remember and implement (e.g., intramuscular (IM) injection of adrenaline).

Patients having an anaphylactic reaction in any setting should expect the following as a minimum:

  • Recognition that they are seriously unwell.
  • An early call for help.
  • Initial assessment and treatments based on an ABCDE* approach.
  • Adrenaline therapy if indicated.
  • Investigation and follow-up by an allergy specialist.

 

Executive Summary

  • The UK incidence of anaphylactic reactions is increasing.
  • Patients who have an anaphylactic reaction have life-threatening airway and/or breathing and/or circulation problems usually associated with skin and mucosal changes.
  • Patients having an anaphylactic reaction should be recognised and treated using the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach.
  • Anaphylactic reactions are not easy to study with randomised controlled trials.  There are, however, systematic reviews of the available evidence and a wealth of clinical experience to help formulate guidelines.
  • The exact treatment will depend on the patient's location, the equipment and drugs available, and the skills of those treating the anaphylactic reaction.
  • Early treatment with intramuscular adrenaline is the treatment of choice for patients having an anaphylactic reaction.
  • Despite previous guidelines, there is still confusion about the indications, dose and route of adrenaline.
  • Intravenous adrenaline must only be used in certain specialist settings and only by those skilled and experienced in its use.
  • All those who are suspected of having had an anaphylactic reaction should be referred to a specialist in allergy.
  • Individuals who are at high risk of an anaphylactic reaction should carry an adrenaline auto-injector and receive training and support in its use.
  • There is a need for further research about the diagnosis, treatment and prevention of anaphylactic reactions.

 

Summary of Changed from Previous Guidelines

  • The recognition and treatment of an anaphylactic reaction has been simplified.
  • The use of an Airway, Breathing, Circulation, Disability, Exposure (ABCDE)* approach to recognise and treat an anaphylactic reaction has been introduced.
  • The early use of intramuscular adrenaline by most rescuers to treat an anaphylactic reaction is emphasized.
  • The use of intravenous adrenaline to treat an anaphylactic reaction is clarified.  It must only be used by those skilled and experienced in its use in certain specialist settings.
  • The age ranges and doses for adrenaline, hydrocortisone and chlorphenamine have been simplified.

 

To view the full version of 'Emergency Treatment of Anaphylactic Reactions' please visit the Resuscitation Council Uk website on www.resus.org.uk.

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