Anaphylaxis

Anaphylaxis is a rapidly evolving systemic hypersensitivity reaction that can obstruct the airway, impair breathing or cause circulatory collapse. It is a clinical emergency: recognition, intramuscular epinephrine and emergency support occur together. Do not wait for every diagnostic criterion, a rash, an intravenous line, laboratory testing or a prescriber callback when anaphylaxis is suspected and an authorized emergency pathway is available. Think anaphylaxis when an acute illness develops over minutes to several hours with typical skin or mucosal findings plus respiratory compromise, reduced blood pressure or end-organ symptoms, or severe gastrointestinal symptoms. Also recognize that acute hypotension, bronchospasm or laryngeal involvement after a known or highly probable allergen can be anaphylaxis even without hives or angioedema. Skin findings may be absent, and a patient can worsen after initially mild symptoms. The first-line medicine is epinephrine given intramuscularly into the mid-anterolateral thigh. The RN simultaneously calls for emergency assistance, assesses airway, breathing, circulation, mental status and skin, positions the patient safely, and removes an ongoing trigger when this can be done without delaying treatment. Oxygen, fluids, bronchodilators and other medicines are...