Anaphylaxis

Low complexity — Circulation

Goals

  1. Recognise an allergic reaction or anaphylaxis and apply nursing interventions accordingly.
  2. Recognise and describe the systemic physiology in anaphylaxis.
  3. Provide treatment recommendations.

Anamnese

  • Name: Mr Smits
  • Age: 59 years
  • Family: Married
  • Occupation: Horse breeder
  • Cultural: Atheist

AMPLE

A: Unknown

M: Recently started rivaroxaban

P: Pulmonary embolism (1 year ago) - Atrial fibrillation

L: Bread meal 1 hour ago

E: Shortness of breath and itching over the entire body

SBAR

S: Mr Smits has just been admitted to your ward due to increasing shortness of breath and nausea. He says he is feeling very unwell. He is now asking you to come to him because his symptoms are worsening.

B: Mr Smits is 59 years old. His history includes pulmonary embolism (1 year ago) and atrial fibrillation.

A: See ABCDE

R: Please assess the patient using ABCDE and apply interventions where necessary.

Situation at the start of scenario

A: Clear, moderate swelling of lips and tongue, faintly audible inspiratory stridor.

B: RR 23 breaths/min, increased work of breathing, using accessory breathing muscles, symmetrical thoracic excursions, normal jugular veins, mild inspiratory stridor over all lung fields, saturation 94%.

C: Blotchy red skin, CRT 2 sec, HR 96 bpm, normal regular pulse, peripherally warm and dry, BP 113/59 mmHg.

D: Alert on AVPU, anxious, glucose 6.4, pupils PEARL.

E: Temp 37.5°C, red rash over trunk, arms and face, facial swelling. No oedema in legs. Urine output: spontaneous 400 ml 30 minutes ago.

Situation at the end of scenario

A: Potentially compromised, increased swelling of lips and tongue, faintly audible inspiratory stridor.

B: RR 31 breaths/min, increased work of breathing, using accessory breathing muscles, symmetrical thoracic excursions, normal jugular veins, mild inspiratory stridor over all lung fields, saturation 84%.

C: Blotchy red skin. Peripherally warm. CRT 4 sec. HR 117 bpm regular, BP 102/48 mmHg.

D: Alert on AVPU. Anxious. Glucose 6.4, pupils PEARL.

E: Temp 37.6°C, increasing red skin rash, facial swelling increasing. No oedema in legs.

Recommendations

  • Repeat EpiPen if necessary