Question: When dealing with a VSA FB obstruction, directives are to analyze once, load and go, revert to medical cardiac arrest if airway clears. Knowing the concern is no air to the patient due to the obstruction, would it not be advantageous to include airway blockage due to anaphylaxis as a one analysis directive and when or if the epi allows for the delivery of air, revert to a medical cardiac arrest? The airway is blocked either way.

 Thanks for your question. A similar question and answer were posted in January 2013. It is interesting that you would choose to follow the Foreign Body Airway Obstruction Cardiac Arrest Medical Directive. While we follow your rationale that the patient's airway may have been swollen closed due to the anaphylaxis, not all patients in cardiac arrest from anaphylaxis have a fully obstructed airway. We would suggest that patients who arrest from anaphylaxis should be managed as per the Medical Cardiac Arrest Medical Directive (where IM epinephrine for anaphylaxis is indicated and referenced). Basically, in a similar fashion to hanging, electrocutions and drowning, these arrests should be managed as cardiac arrests from an asphyxial etiology.

Our education team has surveyed other Regional Base Hospital Programs (RBH) as to their teaching surrounding "unusual circumstances" which allows paramedics to transport following the first NSI for certain etiologies of cardiac arrests (toxicologic and paediatric) as per the Medical Directive. Given the infrequent nature of anaphylaxis based cardiac arrests and that the underlying pathophysiology is different than say a cardiac ischemia based cardiac arrest, the SWORBHP would support paramedics opting to transport anaphylaxis cardiac arrests following the first NSI (and once epinephrine has been administered as per the directive) if they so choose. Remaining on scene and completing the Medical Cardiac Arrest Medical Directive is also an acceptable strategy for these patients.

Thanks again for the excellent question!

Cardiac/Circulation,Foreign Body Airway Obstruction,Medical Cardiac Arrest,Miscellaneous

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