Contributor: Dr. Taylor Lynch
Educational Pearls:
Time of arrival until intubation was 26 minutes but nobody tried anterior neck access like a cricothyrotomy until his dad arrived
Traditional ACLS protocol is not enough for anaphylactic respiratory arrest
Circulating O2 from compressions alone is not enough to sustain the brain
Patients need a definitive airway and endotracheal tube is the best method
BVM ventilation is not enough to get patients the oxygen they need
Time to anoxic brain injury during a respiratory arrest is 4 minutes
Definition of anaphylactic shock:
Acute laryngeal involvement with bronchospasms after known exposure to an allergen
Do not need to have skin symptoms like the classic wheal and flare
Must also have either hypotension (from vasodilation or end-organ hypoperfusion) or severe GI symptoms (crampy abdominal pain or repetitive vomiting)
Treatment of anaphylactic shock:
Push-dose IV epinephrine is better than IM epinephrine because IM epinephrine takes 4 minutes to circulate and get to the lungs
Ketamine has broncho-dilating properties so it can be used as an induction agent for intubation
Albuterol and ipratropium as continuous bronchodilators
Magnesium and IV steroids
AMAX4 acronym
Adrenaline, Muscle relaxant, Airway, Xtra (bronchodilators, ventilation, vasopressors, and consideration of pneumothorax), 4 minutes to anoxic brain injury
References
Commins SP. Outpatient Emergencies: Anaphylaxis. Med Clin North Am. 2017;101(3):521-536. doi:10.1016/j.mcna.2016.12.003
Ring J, Beyer K, Biedermann T, Bircher A, Duda D FJ et al. Guideline for acute therapy and management of anaphylaxis. S2 guideline of DGAKI, AeDA, GPA, DAAU, BVKJ, ÖGAI, SGAI, DGAI, DGP, DGPM, AGATE and DAAB. Allergo J Int. 2014;23(23):96-112.
McKenzie B. AMAX4: Every Second Counts. Accessed Sunday, November 26, 2023. https://www.amax4.org/
Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit, OMSII
