Angioedema (>18 years)



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Angioedema (>18 years)

Airway compromise?

Consider allergist consult

Signs of severe disease?

Reassess clinical status

Resolution of any airway signs/symptoms?

Epinephrine injection

Famotidine injection
Dexamethasone injection
Diphenhydramine injection
  • Identify potential triggering allergen
  • Discharge home with
  • Epinephrine auto-injector
  • H1 blocker
  • Prednisone taper

Admit for observation (stepdown/ ICU)

Bradykinin Mediated Angioedema

  • Supportive care (analgesics, antiemetics, etc. as needed)
  • In refractory cases or with airway involvement, FFP 2 units IV
  • May give targeted therapy with allergist consultation

Fresh Frozen Plasma (FFP)
Inclusion Criteria
  • Clinical suspicion for angioedema
Exclusion Criteria
  • None
  • Proceed to intubation or laryngoscopy
  • Ketamine @ 1- 1.5mg/kg IV preferred agent
  • Backup cricothyrotomy kit must be at bedside and ready
  • BiPaP may help as a temporizing measure
  • If there is time obtain ENT and Anesthesia consultation; do not delay airway intervention for these consultations

Ketamine injection

Signs of acute airway compromise in angioedema

  • Stridor
  • Voice change
  • Dyspnea
  • Tongue/throat swelling
  • Drooling

Determine angioedema type

Histamine

Non-histamine

Urticaria

No rash

Wheezing

HAE/ACE-I history

Sudden onset

Gradual Onset

Shock

Abdominal pain

Signs of severe disease

  • Airway involvement
  • Wheezing
  • Shock
  • Multisystem compromise




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