Anaphylaxis
Scenario
A 2-year-old presents with difficulty breathing.
On arrival you find out the child has known nut allergies and was playing at the neighbor's house where he had a granola bar for snack about 15 minutes ago. The child quickly developed hives and difficulty breathing.
Exam
The child is pale and anxious with vomit on their shirt, hives, is coughing frequently with subcostal retractions and tachypnea.
Discussion and Do Guide
1. Use your pediatric assessment triangle: Sick or not sick?
2. What is your primary concern for this child: Anaphylaxis
Why?: 2 systems involved, severe symptom with work of breathing
3. What medication or equipment do you want for this child? IM Epinephrine! (Here you might get a lot of answers such as monitors, IV access, Benadryl etc., but the most important treatment intervention for Anaphylaxis is IM Epinephrine).
4. How do you know the right size of equipment or medication dosing for this patient? (have the team measure the mannequin) Give weight of 10kg or 2yo.
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Find and touch the equipment you need to give IM epi. (med, 3-way stopcock, 1mL, 3mL syringe)
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How do you know how much medication to give? Can you show me?
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Draw up the epinephrine dose for this patient: 0.1mL. How do you give it? IM
5. What are your next priorities for this patient? Reassess, 2nd dose epi ready, access
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Touch the equipment you might need: face mask, oxygen, IV access, IO access, NS or LR bolus, Benadryl, 2nd epi dose etc., albuterol, steroids, racemic epi (Identify what is part of YOUR protocol/pathway)