You are working in the clinic when a nurse knocks on your door, looking concerned. She has just treated a 34 yo female patient for suspected STI with oral azithromycin and IM ceftriaxone, given 5 min ago in the clinic. The patient is now flushed and complaining of feeling unwell.
The nurse is concerned this could be anaphylaxis.
What is your immediate management?
The patient should be quickly and fully assessed. They should be placed supine, with feet elevated in possible. A full set of vitals should be taken.
The resident should be very closely watched symptoms of anaphylaxis.
What symptoms do you watch for?
Symptoms can come on very rapidly and progress quickly. Given the severity of anaphylaxis, a low threshold needs to be met to prompt a response.
Body systems include:
Skin
- itch
- urticaria
- periorbital edema
|
Respiratory
- wheeze
- nasal congestion, rhinorrhea
- oral edema
|
Gastrointestinal
- nausea
- abdominal pain
- vomiting, diarrhea
|
Cardiovascular
- tachy/bradycardia
- palpitations
- chest pain
- hypotension
- syncope
|
Neurologic
- anxiety
- headache
- altered mental status
- dizziness
- difficulty hearing
|
Other
- incontinence
- uterine cramping
|
The patient is clearly and rapidly becoming unwell. She is distressed,I with generalized itch and skin erythema. You note changes in her voice.
How do you respond?
Given the clinical picture, do not spend more time assessing at this point, before providing treatment. Ensure you have help from colleagues, who can help with the following concurrently:
- Call 911, and print the chart for transfer.
- Prepare and administer epinephrine, according to you treatment protocol; this may be repeated every 5-15 minutes.
Take a moment to review where your epinephrine is located, and how you would deliver an injection.
- If you have not done so, position the resident supine, with legs elevated. If airway compromise is present, the patient may prefer to be upright.
- Apply oxygen to keep saturation >92%.
- Provide salbutamol MDI if wheeze is evident.
- Give Benadryl (diphenhydramine), but this is helpful for symptomatic itch only.
- Monitor vitals and record events.
The Paramedics soon arrive. Practice handing over.
Use an SBAR format, reviewing a clinical diagnosis of anaphylaxis, and what has transpired.
Speak clearly and with organization of thought.
The patient has a patent airway and stable vitals when leaving. You learn that a further dose of epinephrine was given in the ED, along with intravenous steriods. She was observed for 6 further hours, and was then discharged with a script for an epi-pen.
