Resuscitation and Anaphylaxis
in hospital and in the community
Sean Turner, Senior Pharmacist Clinical Research
Alder Hey Children's Hospital, Liverpool
Resuscitation
In adults the most common cause of a cardiopulmonary arrest is a primary cardiac event.
In children arrests are often the end result of a progressive deterioration in respiratory or cardiac function.
Consequently, the presenting arrhythmias differ. In children asystole accounts for 80-90% of presenting
arrhythmias, however, ventricular fibrillation is the most common arrhythmia seen in adults.
Arrests in children present three main problems:
- choice of drug
- choice of dose
- route of administration
The European Resuscitation Council (ERC) produced guidelines for children for the first time in 1994. These
outline treatment strategies for the three common arrhythmias seen in children:
- asystole
- electromechanical dissociation
- ventricular fibrillation.
The choice of dose in children presents a major problem. In 1988 Oakley highlighted the difficulties doctors
have in choosing the appropriate dose of a drug to use in a paediatric arrest. He produced a dosage chart to
overcome these issues. At Alder Hey we have designed a similar chart to reflect practice here and can be
found on the back cover of the Alder Hey Book of Children's Doses.
The ideal route of administration is the intravenous (IV) route. Obtaining IV access in a child following a
cardiopulmonary arrest, however, may be difficult. An alternative route, that is becoming increasingly well
used, is the intraosseous route.
With the use of drugs such as high dose morphine, particularly in terminal care patients, there is an increased
risk of cardiopulmonary arrest occurring outside the hospital environmnment. This raises several issues including
decisions on whether a patient is for resuscitation or not. This requires discussion between the GP, McMillan
nurses and the parents. If resuscitation is required should we be providing information and drugs?
Anaphylaxis
Anaphylaxis is an acute hypersensitivity reaction to foreign proteins. Usually drugs, food or insect stings.
Symptoms range from mild erythema to severe life threatening anaphylactic shock. The incidence of anaphylaxis
is unknown but there are an increasing number of anaphylactic reactions to food particularly nuts. The general
management of anaphylaxis consists of allergen avoidance, if possible, supported by drug management.
Adrenaline and antihistamines are the mainstays of drug treatment. There is considerable debate over who to
provide adrenaline for. Patients who may require adrenaline at home includes those at risk of life threatening a
naphylaxis and those on home IV therapy. The provision of adrenaline, however, does have a number of drawbacks.
Another group who may require drugs for anaphylaxis are nurses giving immunisations in the community. As
well as supplying the drugs should we be providing treatment algorithms, training and dosage information?
There is controversy over the appropriate form of adrenaline whether the Epi-pen, minijet, Epihaler or syringe
and ampoule should be used...
All pages copyright ©Priory Lodge Education Ltd 1994,1995,1996.