If clinical manifestations of shock do not respond to drug treatment give1-2 litres IV fluid. Rapid infusion or one repeat dose may be necessary
• An inhaled beta 2 agonist such as salbutamol may be used as an adjunctive measure if bronchospasm is severe and does not respond rapidly to other treatment.
• If profound shock judged immediately life threatening give CPR/ALS if necessary. Consider slow IV adrenaline 1:10,000 solution. This is hazardous and is recommended only for an experienced practitioner who can also obtain IV access without delay.
Note the different strengths of adrenaline that may be required for IV use.
• If adults are treated with an adrenaline auto-injector, the 300 micrograms will usually be sufficient. A second dose may be required. Half doses of adrenaline may be safer for patients on amitriptylline, imipramine or beta blocker.
• A crystalloid may be safer than a colloid.
Figure 2.1. Anaphylaxis treatment algorithm. Reproduced with kind permission of the Resuscitation Council UK.
For all severe or recurrent reactions and patients with asthma give hydrocortisone 100 mg IM or slow IV
• If the patient is unresponsive - open airway, using head tilt and chin lift.
• Look in the mouth. If a foreign body is visible, attempt to remove it using suction or forceps.
• Keeping the airway open, look, listen and feel for no more than 10 seconds to determine if the patient is breathing normally.
• Assess the carotid pulse for no more than 10 seconds simultaneously.
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