Anaphylactic shock

Type I IgE mediated hypersensitivity reaction. Release of histamine and other cytokines

More common in atopic individuals

Precipitants

• Drugs - penicillin and contrast media
• Latex
• Stings, eggs, fish, peanuts, strawberries 

Presentation

• Itching, sweating, diarrhoea, vomiting, erythema, urticaria, oedema (larynx, lids, tongue, lips) 
• Wheeze, laryngeal obstruction, cyanosis
• Tachycardia, hypotension 

Management

1. Secure the airway - 100% O2
2. Remove cause
3. Raising feet may help restore circulation
4. Adrenaline IM 0.5mg 1:1000 - repeat dose every 5 min if needed as guided by BP, pulse, and respiratory function until better.
5. Secure IV access
6. Chlorphenamine 10mg IV and hydrocortisone 200mg IV (not sure if evidence base is still for this) 
7. 0.9% saline 500ml over 15 mins up to 2L. Titrate against BP
8. If still hypotensive admission to ICU and expert help need