Anaphylaxis OSCA

Check for dangers, ensure scene safety. PPE donned

Introduce yourself - name and role

Paediatric Assessment Triangle - assess tone, lookaze, consolability, speech, interactiveness

Identify anaphylaxis, time-critical condition, difficulty breathing

Gain consent to assess and treat from child and mother

Ask patient's name

Position patient upright for easier breathing

Remove sting from child by scraping it away

Consider adrenaline - check CPM first. Check for general allergies (say "no contraindication"), then confirm anaphylaxis as a positive indication.

Gain consent to put needle in child's leg from mother and child

After checking CPM, mention dose of IMI adrenaline, 300microg if 6 years or above, 150microg if under 6 years. Repeat every 5 mins. Confirm with partner - TREEDEAR - time, reason, education, expiry, documentation, evaluation, assessment, refusal. Administer in neb

Airways - state observations - a) tongue and lips swollen, b) drooling, c) hoarse voice, d) stridor

Call for ICP backup

Assess breathing - RATES (AND rhythm) - expose chest

Physical breathing observations - positioning, retraction (intercostal muscles), head bobbing, gasping, grunting, nasal flaring

Gain consent to give oxygen

Oxygen - 15L high-flow non-rebreather

Gain consent for salbutamol, ipatropium bromide, hydrocortisone

Salbutamol - check CPM first. Confirm wheeze (bronchospasm) as a positive indication. Check allergies, say "no contraindication"

After checking CPM, mention dose of nebulised salbutamol, 5mg/2.5ml. Repeat as required, every 10 minutes. Confirm with partner - TREEDEAR - time, reason, education, expiry, documentation, evaluation, assessment, refusal. Administer in neb

Ipatropium bromide - check CPM first. Confirm wheeze (bronchospasm) as a positive indication.

After checking CPM, mention dose of nebulised ipatropium bromide, 250microg in 1 x 1ml ampoule (atrovent). Confirm with partner - TREEDEAR - time, reason, education, expiry, documentation, evaluation, assessment, refusal. Administer in neb

Consider hydrocortisone - check CPM first. Check for general allergies (say "no contraindication"), then confirm anaphylaxis as a positive indication.

Mention bodyweight calculation (age + 4 x 2). Then mention dose, 4mg/kg IMI. Ampoules come in 100mg to be reconstituted in 2ml saline. Do not exceed 100mg. Confirm with partner - TREEDEAR - time, reason, education, expiry, documentation, evaluation, assessment, refusal. Administer in shoulder

Assess physical circulation signs - pallor, mottling, waxy appearance, cyanosis, obvious bleeding

Circulation observations - palpate pulses, cap refill, HR, B/P, 4-lead

IV Access - gain consent, 22 gauge cannula, explain procedure

Fluids - check indication, confirm 10ml/kg. spike bag, administer.

Assess disability - GCS, Temp, BGL, Pupils

Exposure - remove clothes, control for temperature