Anaphylaxis Information

allnurses Guide · Oct 19, 2009

Hello -
If someone has received a shot of penicillin then: begins wheezing, has edamatous airway, bronchoconstriction, and falling blood pressure - would you suction the airway before administering epinephrine? How would one ensure an open airway? Thanks!

No, if a reaction is suspected whether it is anaphylactic or anaphylactoid the first thing that should be done is to give Epi/support the airway (don't worry about suctioning at this time), then benadryl, and then steroids.

Whispera, MSN, RN · Oct 20, 2009

Suctioning is irrelevant in this situation. Suctioning would be useful if the airway was blocked by mucus or saliva, but not if the airway is swollen due to an allergic reaction. Did you mean to ask if it would be appropriate to get an airway inserted ASAP?

amydayre · Oct 20, 2009

You need to give the epi first, but if the patient has an edematous airway, you need more help than just you in the room. One individual (usually the most experienced with the airway) needs to manage the airway with the most basic maneuver to keep it open. This may be by a head tilt chin lift, with a NRB in place or something more advanced such as intubation. If the patient is swelling extremely quickly the provider may elect to intubate to avoid having to do a cricothyrotomy.

studentNURSEwyo · Oct 20, 2009

Thanks everyone - this was actually a test question that I got wrong. I thought the answer was to administer epinephrine, but the "correct" answer was to obtain suction and clear out the oropharyngeal airway. I still think the right answer is to administer epinephrine, and I am going to contest the question...I just wanted to make sure.

allnurses Guide · Oct 20, 2009

Thanks everyone - this was actually a test question that I got wrong. I thought the answer was to administer epinephrine, but the "correct" answer was to obtain suction and clear out the oropharyngeal airway. I still think the right answer is to administer epinephrine, and I am going to contest the question...I just wanted to make sure.

The best way to contest a question is not by asking other nurses, but to find the reference in a textbook and then go from there. You should check out an ACLS manual from your library and then also look through your own textbooks. Sometimes instructors may have thrown the penicillin shot in as a distractor, and something else entirely was going on. It is really hard to judge without knowing the entire question with all available answers.

amydayre · Oct 20, 2009

Thanks everyone - this was actually a test question that I got wrong. I thought the answer was to administer epinephrine, but the "correct" answer was to obtain suction and clear out the oropharyngeal airway. I still think the right answer is to administer epinephrine, and I am going to contest the question...I just wanted to make sure.

Anytime there is a question on a test that deals with Airway, Breathing or Circulation, that is exactly how you approach it, A, B, C. This is to get you in the mode of thinking I need to establish a clear airway before I can breathe for the patient...When this happens in real life though, you call for help, so you have more hands on the patient and can give the epi while someone else manages the airway.

allnurses Guide · Oct 20, 2009

Anytime there is a question on a test that deals with Airway, Breathing or Circulation, that is exactly how you approach it, A, B, C. This is to get you in the mode of thinking I need to establish a clear airway before I can breathe for the patient...When this happens in real life though, you call for help, so you have more hands on the patient and can give the epi while someone else manages the airway.

Actually giving Epinephrine is treating the airway (B2 agonist activity of Epi will bronchodilate the lungs), it will also help breathing almost immediately, and it will support the cardiovascular status (B1 and alpha1 agonist activity). Suctioning is probably not going to do anything for someones airway that is having a true allergic reaction. The problem in a patient having allergic reaction isn't going to be secretions it is going to be swelling/edema of the airway.

Now the question could have taken on whole different meaning if it said, "What is the 1st nursing intervention in X". Then it would be nonpharmalogical approach since as a nurse you can't prescribe medications.

Good Luck and hope the information helps on your test.