Medical

Anaphylaxis with airway compromise

Before / During / After / Pitfalls

Before

• IM epinephrine and anaphylaxis treatment come first; airway plan runs in parallel.
• Assess for tongue/laryngeal edema, wheeze, hypotension, vomiting.
• Prepare difficult airway/surgical backup if swelling is progressing.

During

• Preoxygenate with PEEP if needed; avoid delay in crashing edema.
• Choose induction with shock risk in mind and have pressors/resuscitation ready.
• Expect bronchospasm and high pressures after tube.

After

• Continue epinephrine infusion/adjuncts per protocol.
• Watch for biphasic reaction and ongoing bronchospasm/edema.
• Plan ICU/airway observation if edema significant.

Pitfalls

• Focusing on intubation while delaying epinephrine.
• No cric backup for progressive edema.
• Under-treating post-tube bronchospasm/shock.