Anaphylaxis

Mid 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 de Wild
  • Age: 52 years
  • Family: Married
  • Occupation: Radio DJ
  • Cultural: Not known

AMPLE

A: Unknown

M: Recently started methotrexate

P: Ulcerative colitis and cholecystectomy

L: Bread meal 3 hours ago

E: Shortness of breath and itching

SBAR

S: Mr de Wild is admitted to your ward due to a flare-up of ulcerative colitis. He has just started new medication for this. He is now asking you to come to him because his symptoms are worsening.

B: Mr de Wild is 52 years old. His history includes ulcerative colitis and cholecystectomy.

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, audible breathing.

B: RR 25 breaths/min, increased work of breathing, using accessory breathing muscles, symmetrical thoracic excursions, normal jugular veins, inspiratory stridor over all lung fields, saturation 91%.

C: Blotchy red skin, CRT 2 sec, HR 98 bpm, normal regular pulse, peripherally warm and dry, BP 103/48 mmHg.

D: Alert on AVPU. Anxious. Glucose 8.2, pupils PEARL.

E: Temp 37.5°C, red rash over trunk, arms and face, facial swelling. No oedema in legs. Urine output: spontaneous 350 ml 1 hour ago.

Situation at the end of scenario

A: Compromised, increased swelling of lips and tongue, audible breathing.

B: RR 35 breaths/min, increased work of breathing, using accessory breathing muscles, symmetrical thoracic excursions, normal jugular veins, inspiratory stridor over all lung fields, saturation 76%.

C: Blotchy red skin (100%). Peripherally warm. CRT 4 sec. HR 121 bpm regular, BP 78/34 mmHg.

D: Alert on AVPU. Anxious. Glucose 8.2 mmol/l, pupils PEARL.

E: Temp 37.7°C, increasing red skin rash, facial swelling increasing. No oedema in legs.

Recommendations

  • Repeat EpiPen if necessary