Podcast 879: A Case of Pediatric Anaphylactic Shock

<p dir="ltr"><strong>Contributor: Dr. Taylor Lynch</strong></p> <p dir="ltr"><strong>Educational Pearls:</strong></p> <ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Time of arrival until intubation was 26 minutes but nobody tried anterior neck access like a cricothyrotomy until his dad arrived</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Traditional ACLS protocol is not enough for anaphylactic respiratory arrest</p> </li> <ul> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Circulating O2 from compressions alone is not enough to sustain the brain</p> </li> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Patients need a definitive airway and endotracheal tube is the best method</p> </li> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">BVM ventilation is not enough to get patients the oxygen they need</p> </li> </ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Time to anoxic brain injury during a respiratory arrest is 4 minutes</p> </li> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Definition of anaphylactic shock:</p> </li> <ul> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Acute laryngeal involvement with bronchospasms after known exposure to an allergen</p> </li> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Do not need to have skin symptoms like the classic wheal and flare</p> </li> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Must also have either hypotension (from vasodilation or end-organ hypoperfusion) or severe GI symptoms (crampy abdominal pain or repetitive vomiting)</p> </li> </ul> <li dir="ltr" aria-level="1"> <p dir="ltr" role="presentation">Treatment of anaphylactic shock:</p> </li> <ul> <li dir="ltr" aria-level="2"> <p dir="ltr" role="presentation">Push-dose IV epinephrine is better than IM epinephrine because IM epinephrine takes 4 minutes to circulate and get to the lungs</p> </li> <li dir="ltr" aria-level="2"> <p dir