Life threatening angioedema – know your stuff!
PROTECT THIS AIRWAY
Angioedema can kill and it does so by airway obstruction.
You need to be updated on the latest thinking! Its not all about adrenaline and antihistamines. You need to drill down further if things are not getting better.
Here is a quick FOAMEd review to get you up to speed!
First watch this great summary by Dr Mattu and Dr Roberts!
Amal Mattu and Jim Roberts – VCast on Angioedema
then go over and read this by Dr Andrew Volans and Prof Simon Carley
ARE YOU SURE ITS ALLERGIC?
Finally try to access and read this recent article on FFP use in airway threatening angioedema
Fresh Frozen Plasma for Progressive and Refractory Angiotensin-Converting Enzyme Inhibitor-induced Angioedema
Bottom line.. think about FFP if angioedema is not responding to adrenaline and antihistamines and airway is being threatened.
Airway obstruction can be insidious and complete obstruction unpredictably sudden. Its well worth learning awake airway exam techniques so you can assess the larynx early..go to ENT clinic and practice under supervision. Learn to assess airway carefully and reliably.
Above all know your surgical airway plan meticulously. This is one of those situations where RSI and oral airway interventions are high risk for failure if performed too late. If adrenaline, antihistamines and FPP are not helping, next step is airway control, earlier the better. Consider it like an airway burn at this point.
And remember when prescribing ACE inhibitors, educate patients about angioedema and what to do if it occurs!
Ok now you are updated!