Emergency Medicine Cases Ep 187 Crashing Anaphylaxis – AMAX4 Algorithm and The Max McKenzie Case
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Sep 26, 2023 Dr. Ben McKenzie, EM physician and a PhD candidate, discusses the AMAX4 algorithm for anaphylaxis and asthma resuscitation. Topics include predicting severity, securing the airway, simulations, paralytics and bronchodilators, and taking action against anaphylaxis and severe asthma.
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Max's Story
- Dr. Ben McKenzie's 15-year-old son, Max, died from anaphylaxis after accidentally ingesting walnuts.
- Despite prompt EpiPen use and ambulance arrival, Max suffered respiratory arrest and died 13 days later.
Anaphylaxis Arrest Predictors
- Predicting anaphylaxis arrest is difficult, but cofactors like asthma, upper respiratory tract infections, age, and cardiovascular problems increase risk.
- All allergens aren't equal; food allergies often involve bronchospasm, while insect bites can be predominantly vascular.
IV Epinephrine Administration
- For severe anaphylaxis, administer IV epinephrine if the patient deteriorates despite two IM doses.
- IV epinephrine's immediate effect is crucial for critically hypoxic or hypotensive patients.