Anaphylaxis Management Medical Slides

Present the evidence-based protocol: IM epinephrine 0.01 mg/kg (1:1000 concentration, max 0.5 mg adults, 0.3 mg children) into the anterolateral thigh. May repeat every 5-15 minutes if inadequate response. Emphasize that epinephrine is the ONLY first-line treatment — antihistamines and steroids are adjuncts only and should never delay epinephrine. Present barriers to administration: fear of adverse effects (unfounded at IM doses), difficulty recognizing anaphylaxis, reliance on antihistamines. Reference the 2020 WAO position paper.

Present biphasic anaphylaxis: recurrence of symptoms after initial resolution without re-exposure, occurring in 1-20% of cases (varies by study). Median onset: 8-11 hours after initial reaction (range 1-72 hours). Risk factors for biphasic reaction: delayed epinephrine administration, severe initial reaction, unknown trigger, requirement for >1 dose of epinephrine. The 2020 ACAAI/AAAAI guidelines recommend 4-6 hour observation for most patients, extended to 12-24 hours for severe presentations or risk factors.

Present the escalation pathway for patients not responding to 2-3 doses of IM epinephrine: (1) IV epinephrine infusion 0.1-1 mcg/kg/min (use cardiac monitor), (2) aggressive IV fluid resuscitation (1-2 L NS bolus — distributive shock with capillary leak), (3) glucagon 1-5 mg IV for patients on beta-blockers (bypasses beta-receptor blockade), (4) vasopressin for refractory hypotension, (5) methylene blue 1.5 mg/kg for vasoplegia unresponsive to catecholamines. Emphasize early intubation if airway edema is progressing.