managing-anaphylaxis
Managing Anaphylaxis
Guides anaphylaxis recognition using NIAID/FAAN diagnostic criteria, enforces epinephrine-first treatment protocol, and structures observation timing to capture biphasic reactions.
Why This Skill Exists
Anaphylaxis kills approximately 1,500 people annually in the United States, and the majority of deaths are associated with delayed epinephrine administration. Studies consistently show that patients who receive epinephrine within 5 minutes of symptom onset have near-zero mortality, while delays beyond 30 minutes dramatically increase the risk of fatal cardiovascular collapse. Despite this, epinephrine remains underused—only 50-60% of patients presenting with anaphylaxis to EDs receive epinephrine, often because clinicians fail to recognize anaphylaxis without classic urticaria or wait for "more severe" symptoms before acting.
The biphasic reaction rate of 5-20% means observation decisions directly impact patient safety. Premature discharge has resulted in deaths from recurrent anaphylaxis hours after initial resolution. This skill enforces the evidence-based standard: epinephrine is always first-line, antihistamines and steroids are adjuncts only, and observation duration is risk-stratified.