Importance of Lying Down During Anaphylaxis

So, we all know the steps of what to do when a person is having an allergic reaction.

 

What to do if someone has anaphylaxis:
  1. The first line treatment for symptoms is the EpiPen which contains adrenaline (epinephrine) administered into the upper outer muscle of the thigh. Use an adrenaline auto-injector if the person has one – but make sure you know how to use it correctly first.
  2. Call 999 or 112 for an ambulance immediately (even if they start to feel better) – mention that you think the person has anaphylaxis.
  3. Be prepared to use a second EpiPen if you don’t get relief within 5 to 15 minutes, or if there’s a delay in getting to an emergency room and symptoms recur.
And we know the steps of how to use the Epi-Pen:

 

We have it drilled into our heads to ‘’always have our epi-pen with us and administer it immediately” if we feel an allergic reaction occuring.
However, a very important step that often gets overlooked due to the panic of administering the Epi-Pen and getting the individual into hospital, is lying down.
 

 

Why lying down is crucial during Anaphylaxis
During anaphylaxis, the release of allergic mediators, or chemicals like histamine, can cause the blood vessels to get bigger, dilate and become leaky. As a result, there can be massive fluid shifts out of the blood vessels causing blood and fluid to move into the surrounding tissues and make it harder for blood to return back to heart. Therefore, blood pressure drops and becomes low.
To help prevent blood pressure from suddenly dropping, if you’re having anaphylaxis, you should lie down on the ground or sit on the ground with your legs stretched out in front of you or legs elevated. This will help ensure blood continues to flow to the heart and to other major organs in the body.
Sudden standing must be avoided as this may increase the risk of a fatal reaction. Once an EpiPen, the treatment for anaphylaxis is given, it will reverse the symptoms by constricting the blood vessels, reducing the leakage of fluid and relaxing the airways.

 

While waiting for the ambulance, stay with the individual.  Get another person to show paramedics where the patient is.
  • If possible, lie down before using your EpiPen (but don’t delay if lying down isn’t an option).
  • If feeling weak or dizzy, lie down with your legs elevated. Do not try to sit up; it may prevent blood from reaching the heart and brain.
  • Let the patient lie on their back with their legs raised while waiting for the ambulance. This position will help the blood flow to the vital organs of the body (heart, brain and lungs) and help to reduce the symptoms of shock (1).
  • If the patient is finding it difficult to breathe, they may prefer to be in a more upright position. Do not raise them into an upright position until they have been seen by a doctor because this can cause a sudden drop in blood pressure, which can be dangerous (1).
  • If the patient is vomiting or feels nauseous, place them on their side or in the recovery position so that if they vomit, they will not choke.  It is very important to keep their airways clear.
  • The paramedics should take the patient to the ambulance by stretcher. Do not make the patient stand up or walk to the ambulance.
  • IMPORTANT: Do not have the patient sit up or stand up suddenly during an anaphylactic reaction, even after receiving adrenaline. Sudden changes of position can lead to severe complications, even death.

 

 

  • ALWAYS give adrenaline autoinjector first, and then asthma reliever inhaler if someone with known asthma and allergy to food, or medication has sudden breathing difficulties (including wheeze, persistent cough or hoarse voice) even if there are no skin symptoms.
Fatality can occur within seconds if the patient stands or sits up suddenly(1).

 

 

Leaving the hospital

Ask the doctor to prescribe auto-injectors before leaving the hospital.Purchase the auto-injectors as soon as possible.

 

 

Many people may be aware of this and may initially sit down, calm themselves and administer the EpiPen when having an allergic reaction, however when they start to feel a little better they may be inclined to stand up and walk themselves to the ambulance or walk from the car into the hospital.
For me, when I’m starting to feel like I’m having an allergic reaction or unsure if I’m having symptoms, I would walk to the bathroom with a friend so I can fully asses my body and examine my face, eyes and breathing to see if I’m having symptoms. Then I would walk to my bag to get my EpiPens and maybe even make a call to the ambulance myself while sitting up. I know this is completely wrong so I’m going to make a change to my action plan immediately and ensure that I lie down or sit down anytime I feel sympotms and if my EpiPens and phone isn’t on me, to get the people around me to fetch my EpiPen and to call the ambulance while I’m lying down with my legs elevated.

 

Even after administration when one may feel fine after the adrenaline, it is vital to stay sitting or lying down preferably and get another person to show paramedics where you are.
The paramedics should take you to the ambulance by stretcher. Do not stand up or walk to the ambulance.
I am aware individuals may feel they are drawing more attention to themselves or creating a fuss if they lie down on the ground when they think they are having experiencing anaphylaxis but we should DEFINITELY not feel this way. It is vital that we make this part of our Action Plan and ensure others around us are aware of this too so they know what to expect and can help take control of the situation.

 

Action Plan: LEAFIES

  • Lie Down: Do not stand or walk
    • If unconscious, place in the recovery position
    • If having breathing difficulties, sit down with legs stretched out in front
  • EpiPen: Give adrenaline EpiPen
  • Ambulance: Call ambulance
  • Family Contact: Call family contact/emergency contact
  • Inhaler: If someone has asthma, give Epipen first, then 4-5 puffs of asthma reliever inhaler
  • EpiPen: Give another adrenaline EpiPen if symptoms persist or come back
  • Stretcher: The paramedics should take you to the ambulance by stretcher. Do not stand up or walk to the ambulance

 

  • If individual stops breathing, start CPR

 

 

(1)Simon, E. et al. “World Allergy Organization guidelines for the assessment and management of anaphylaxis.” World Health Organization – World Allergy Organization Journal (2011) 21-22.

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