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!

6 Comments
  1. Thanks Minh,
    In support of the FFP… We were recently called to ED for a 83 man who presented with a tongue so swollen it was keeping his mouth fully open and he was virtually unable breathe past it (but remained calmly breathing through his nose!). He had been on an ACE for many months and described recent episodes of morning facial swelling and a burning pruritus, which had failed to respond to steroids and antihistamines (and was awaiting an immunology review).
    Anyway, his tongue had been like this for more than an hour and did not seem to be deteriorating so he was transferred un-intubated to ICU for observation (but with everything ready for a potentially rather difficult intubation…). He had already been given steroids, adrenaline and antihistamines with no apparent benefit, but improved rapidly following FFP administration (as per the paper you linked). He was observed overnight and discharged, and following cessation of the ACE there has not been a recurrence.
    (N=1, but it was a good 1)!

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