Emergency Management of Allergic Reactions in Primary Care Settings

Pre-hospital treatment of anaphylaxis, it is essential to act quickly as this is a life-threatening situation and can cause the patient to go into respiratory arrest or cardiac arrest. Early interventions can improve the patient’s condition. Firstly, a primary survey is essential on first contact. The next key action with a patient having a severe allergic reaction (Anaphylaxis) is where possible remove the trigger if known. But this should not delay in contacting the emergency services or any definitive treatment if this is not possible, have a member of staff outside to meet the solo responder or crew when they arrive to take them directly to the patient.

Reassurance is also essential, reassure the patient what you are doing and try to keep them calm, try to establish if this has happened to them before, do they carry an epi-pen?

It is possible for the patient’s blood pressure to drop, consider placing to patient on the floor to minimise the risk of injury and ensure there is ample space around the patient. In the event of respiratory or cardiac arrest, 360 degrees access is required for the best possible access and treatment.

Depending on your location, what equipment and medication have you got available, are you trained, qualified to use this, are there other members of staff qualified? Always try to have a second person with you.

Where possible have an Automatic External Defibrillator (AED) and Basic Life Support (BLS) equipment, potentially the patient could have a compromised airway at any moment.

Drugs that can be used for the treatment of anaphylaxis are as follows: – Oxygen, Salbutamol, Adrenaline, Chlorphenamine, Hydrocortisone. If possible, Intravenous Access would also be beneficial to the patient and crew as time is crucial with the treatment of anaphylaxis.

Prior to the arrival of the emergency services, a copy of the patients details, this should include a list of personal details, medication, next of kin, medical history, allergies, this will also save time and give a full handover to the solo/crew. Handover is essential, ATMIST is a common acronym amongst many, ATMIST stands for age, time, mechanisms, injuries, signs, treatments.

The treatment would firstly consist of hi-flow oxygen and maintain saturations between 94% to 98%, Then an IM injection of adrenaline 1:1000, consider IV fluids if haemodynamically compromised, consider chlorphenamine, consider hydrocortisone, consider salbutamol nebuliser. Reassess after each step and monitor the patient closely. These are also administered as per guidelines, age dependent or by your local Patient Group Directions (PGD’s).

The signs and symptoms can be all or some of these: – Dizziness, collapse, loss of consciousness, swelling of tongue and/or throat, Difficulty in swallowing or speaking, Wheeze or stridor, Hoarse voice, Difficult or noisy breathing, Erythema, Stomach cramps or vomiting after an insect sting.

Always remember your DR(C)CABC: – danger, response, (CALL FOR HELP) cervical, airway, breathing and circulation and you will not go wrong. Always be prepared for the worse.