Managing Anaphylaxis

Recognizing Anaphylaxis Fast

Mark Ellison: Hey everyone, welcome back to Nursing 101. I’m Mark Ellison, and today we’re talking about something that, honestly, still gets my heart rate up—anaphylaxis. If you’ve ever been in a code or even a simulation where someone’s airway is closing up, you know how fast things can go sideways. So, let’s start with the basics: how do you spot anaphylaxis before it’s too late?

Mark Ellison: The first thing I always tell my students is, listen for stridor. That high-pitched, almost whistling sound when someone’s trying to breathe in? That’s a red flag. You might also hear hoarseness, or notice the patient struggling to speak. Swelling is another big one—lips, tongue, uvula, even the face can puff up in minutes. I remember my first time leading a high-stakes simulation—my palms were sweating, and the “patient” suddenly started gurgling and couldn’t get words out. It was like, one second they were fine, and the next, we were scrambling to keep their airway open.

Mark Ellison: Now, positioning is huge. If the patient’s having trouble breathing, you want to get them into a semi-Fowler’s position—sitting up a bit, so gravity helps keep the airway open. But if they’re hypotensive, you lay them flat with their legs up. I know, it’s a lot to remember, and I still have to pause and think through it sometimes. But whatever you do, don’t let them stand or walk. That can tank their blood pressure and make things worse, fast.

Mark Ellison: And, just a quick tip—always have your airway equipment ready. Intubation tray, suction, trach set, the whole nine yards. You might not need it, but if you do, you’ll want it within arm’s reach. I learned that the hard way in that simulation—thankfully, it was just a drill, but it stuck with me.

Critical Actions and Medications

Mark Ellison: So, you’ve recognized anaphylaxis. What’s next? This is where you move fast, but you’ve gotta stay calm. First-line treatment is epinephrine, no question. IM injection, right into the outer thigh. For adults, it’s usually 0.3 milligrams, and for kids, 0.15. If you’re using an auto-injector, just follow the instructions, but if you’re drawing it up, double-check that dose. I always say, “Measure twice, inject once”—not the best coffee metaphor, but you get the idea.

Mark Ellison: Timing is everything. If symptoms aren’t improving, you can repeat the dose every 5 to 15 minutes. And while you’re doing that, get high-flow oxygen on board—non-rebreather mask, 10 to 15 liters per minute. You want that SpO2 above 90 percent, ideally higher.

Mark Ellison: Next, get IV access—two large-bore lines if you can swing it, especially if the patient’s blood pressure is dropping. Start rapid boluses of isotonic saline—or as ordered by the physician. And if that’s not enough, you might need vasopressors too, but that’s usually under close monitoring.

Mark Ellison: Don’t forget the adjunct meds. Antihistamines like diphenhydramine can help with hives and itching, but they’re not gonna save the airway. Steroids, like methylprednisolone, are more for preventing a biphasic reaction—where symptoms come back hours later. They’re not first-line, but they’re part of the package. And if your patient’s on beta-blockers and not responding to epi, glucagon might be your friend.

Mark Ellison: Oh, and document everything. Every dose, every intervention, every change in status. I know, it feels like you’re glued to the chart, but if things go south—or if symptoms come back later—you’ll want that paper trail. And keep monitoring: vitals, cardiac rhythm, breath sounds, skin, mental status, even urine output. It’s a lot, but it’s how you catch those sneaky biphasic reactions.

Educating for Safety Beyond the Crisis

Mark Ellison: Once the dust settles and your patient’s stable, your job isn’t done. Education is what keeps them safe next time. I always start with the auto-injector—show them how to use it, have them practice with a trainer, and make sure they know to inject into the outer thigh, hold it for the right amount of time, and call 911 right after. Even if they feel better, they need to get checked out.

Mark Ellison: I tell folks, “Carry two auto-injectors everywhere.” You never know if you’ll need a second dose. And check those expiration dates—an expired EpiPen is about as useful as decaf coffee in a night shift, which is to say, not at all.

Mark Ellison: Written emergency action plans are a must. Give them something they can hand to teachers, coaches, or coworkers. And encourage them to follow up with an allergist—sometimes, you can pinpoint the trigger and avoid a repeat performance. I had a patient once who, after a scary reaction, learned to read food labels like a pro and never left home without her auto-injector. She caught a hidden allergen at a potluck and avoided a second crisis—just because she was prepared.

Mark Ellison: And don’t forget the basics: teach them to recognize early symptoms, wear medical alert jewelry, and always let healthcare providers know about their allergies. It’s a lot to take in, but a little education goes a long way and is so important for our patients as Jackie would say.

Mark Ellison: Alright, that’s a wrap for today’s episode on managing anaphylaxis. Thanks for tuning in—next time, we’ll tackle another high-stakes scenario. Until then, keep your skills sharp and your coffee strong. See you soon! For references to this episode please the end of this week's guide.