Pediatric emergency medicine trisk 1673 1673
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myocardial ischemia. Symptoms of impaired cardiovascular function include
dizziness, syncope, seizures, and altered mental status.
Triage Considerations
Because evaluation and management of anaphylaxis is time sensitive, rapid
recognition is critical to mitigate risk of complications. Upon ED arrival, a rapid
cardiopulmonary assessment including a full set of vital signs should be obtained.
Emergent resuscitation should be initiated as indicated. After confirming a patent
airway, supplemental oxygen should be administered for all children with
cardiorespiratory involvement. Children with hypotension or other signs of
impaired cardiac function should be placed in the Trendelenburg position. When
possible, the offending allergen should be removed to prevent further clinical
deterioration. The patient should be monitored for symptoms of life-threatening
anaphylactic reactions including hypotension or signs of respiratory failure (voice
changes, dyspnea, or a sense of impending doom).
Clinical Assessment
After a rapid cardiopulmonary assessment and appropriate interventions have
been initiated (see Fig. 85.1 and Management section), a more detailed
assessment should be performed. A detailed history should include information
regarding potential triggers and timing of allergen exposure, initial and current
symptomatology, prehospital therapies, and historical features that may portend
an increased risk of severe and biphasic reactions (e.g., history of asthma, prior
anaphylactic reactions). Identifying the offending allergen may be obvious
especially among children with prior allergic reactions; however, the trigger may
be unknown or difficult to determine especially for patients exposed to numerous
potential allergens during meals. Although use is uncommon in children,
concurrent medications such as β-blockers, calcium channel blockers, and
angiotensin-converting enzyme inhibitors may augment reaction severity and
complicate management.
