Thread by @DrAkhilRaghavan

Drug of choice for ANAPHYLAXIS in a patient with no response to Epinephrine?
Patient is on Propranolol 60 mg BD for essential tremors.
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Which drug should be given?
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Anaphylaxis is a severe, life threatening systemic hypersensitivity reaction characterized by being rapid in onset with potentially life threatening airway, breathing, or circulatory problems and is usually, although not always, associated with skin and mucosal changes.( ICD-11)

World allergy organisation (WAO) anaphylaxis guidance 2020 has amended criteria for diagnosis of anaphylaxis.

The diagnosis of anaphylaxis is readily apparent in a patient presenting with acute rash, respiratory difficulty, and hypotension after an allergenic exposure, but there are many other disease processes that may present with similar symptoms.

Treatment of anaphylaxis in adults is intramuscular epinephrine 0.3-0.5mg given in anterolateral aspect of thigh ASAP.
It is important to treat anaphylaxis promptly as it appears to be most responsive in its early phases and delayed epineprine inj is associated with fatalities.

Patient responds to epinephrine very fast usually. Incomplete response can be due to rapid fluid shifts during anaphylaxis and bolus iv fluids needs to be given. IV Epinephrine may be required in hypotension.

Although epinephrine should still be first-line 💉even in patients on beta-blockers, if a patient on beta-blockers appears to be refractory to epinephrine, Glucagon can be administered because it has inotropic and chronotropic effects that are not mediated through beta-receptors.

Reference

1)       World Allergy Organization Anaphylaxis Guidance 2020; Cardona et al. World Allergy Organization Journal (2020) 13:100472; doi.org/10.1016/j.waoj…

2)       Rosen's Emergency Medicine - Concepts And Clinical Practice, 9e

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