Allergic Reaction Anaphylactic Shock: Difference between revisions

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===5.02 ALLERGIC REACTION / ANAPHYLACTIC SHOCK===
===5.02 ALLERGIC REACTION / ANAPHYLACTIC SHOCK===


[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01) - Provide [[Medical Gases|OXYGEN]] or assist ventilations as appropriate for patient condition.
*For pediatric patients, refer to Handtevy
*Reactions tend to be more severe if they occur immediately after contact or ingestion
*Exam airway for edema
 
===[[Initial Medical Assessment and Care|INITIAL MEDICAL CARE]] (2.01)===
* Provide [[Oxygen|OXYGEN]] or assist ventilations as appropriate for patient condition.
* Establish IV or administer medications into extremity without bite or injection of allergen.
* Establish IV or administer medications into extremity without bite or injection of allergen.
* Administer medications into areas without hives (urticaria)
* Administer medications into areas without hives (urticaria)


==== ALLERGIC REACTION: ====
=== <span style="color: green;">MILD (urticaria, no respiratory involvement)</span> ===
* If wheezing present:
*[[Diphenhydramine|DIPHENHYDRAMINE (BENADRYL)]] 25-50mg IM/IVP
**[[Bronchodilators|ALBUTEROL (PROVENTIL)]] 2.5 mg via updraft. Monitor heart rate. (Consider [[Bronchodilators|IPRATROPIUM BROMIDE (ATROVENT)]] 0.5mg/2.5cc via updraft)
*Consider [[Solu-Medrol|METHYLPREDNISOLONE (SOLU-MEDROL)]] 125mg IM/IVP if the speed of reaction appears rapid.  
* If hives (urticaria) with history of systemic reaction in past: (All age ranges)
 
**[[Antihistamines|DIPHENHYDRAMINE (BENADRYL)]] 1 mg / kg IVP not to exceed 50 mg slowly over 2 -3 minutes. If no IV access, may give IM
 
* For pediatric patients presenting with a mild or localized allergic skin reaction (urticaria) with no respiratory involvement:
=== <span style="color: gold;">MODERATE (mild respiratory involvement)</span> ===
**[[Antihistamines|DIPHENHYDRAMINE (BENADRYL)]] oral liquid or dissolving tablet
*[[Diphenhydramine|DIPHENHYDRAMINE (BENADRYL)]] 25-50mg IM/IVP  
***For patients 2-6 year old – 6.25 mg PO
*[[Solu-Medrol|METHYLPREDNISOLONE (SOLU-MEDROL)]] 125mg IVP/IM
***For Patients 6-11 year old – 12.5 mg PO
*[[Pepcid|FAMOTIDINE (PEPCID)]] 20mg/50ml IVPB
***For Patients 12 and over – 25 mg PO
*[[Epinephrine|EPINEPHRINE]] UPDRAFT (1mg/1ml + 2ml NS)
* If mild/ moderate reaction:
 
**Administer [[Antihistamines|FAMOTIDINE (PEPCID)]] 20 mg/50 ml IVPB at wide open rate
*[[Albuterol|ALBUTEROL (PROVENTIL)]] 2.5mg via updraft
* Moderate Reaction:
+/-  
**Administer [[Antihistamines|FAMOTIDINE (PEPCID)]] 20 mg/50 ml IVPB at wide open rate
*IPRATROPIUM (ATROVENT) 0.5mg via updraft
**[[Corticosteroids|METHYLPREDNISOLONE (SOLU-MEDROL)]] 125 mg slow IVP
 
**[[Adrenergics|EPINEPHRINE]] 1:1,000 0.3mg SQ
 
* Cardiac Arrest or Cardiopulmonary Arrest Imminent:
=== <span style="color: red;">SEVERE (stridor / airway involvement) </span> ===
**[[Adrenergics|EPINEPHRINE]] 1:10,000 0.3mg IVP (instead of 1:1,000)
*[[Epinephrine|EPINEPHRINE]] 1mg/1ml  0.3-0.5mg IM (may repeat q 10min)
**Consider all appropriate therapeutic and/or pharmacologic modalities to correct the condition.
*[[Diphenhydramine|DIPHENHYDRAMINE (BENADRYL)]] 50mg IM/IVP
*[[Solu-Medrol|METHYLPREDNISOLONE (SOLU-MEDROL)]] 125mg IM/IVP
*[[Pepcid|FAMOTIDINE (PEPCID)]] 20mg/50ml IVPB
*IV NS BOLUS 500-1000ml (maintain systolic BP > 90mm HG)
*[[Albuterol|ALBUTEROL (PROVENTIL)]] 2.5mg via updraft
+/-
*[[Atrovent|IPRATROPIUM BROMIDE [ATROVENT]]] 0.5mg via updraft


=== <span style="color: red;">ANAPHYLACTIC SHOCK / CARDIAC ARREST IMMINENT</span> ===
*[[Epinephrine|EPINEPHRINE]] 0.1mg/1ml  0.5-1mg IVP (may repeat q 10 min)
*IV NS BOLUS 500-1000ml (maintain systolic BP > 90mm HG)


====ANAPHYLACTIC SHOCK:====
[[Category:Medical|0502]]
* If wheezing present, [[Bronchodilators|ALBUTEROL (PROVENTIL)]] 2.5 mg via updraft
**Monitor heart rate. (Consider [[Bronchodilators|IPRATROPIUM BROMIDE [ATROVENT]]])
* [[Adrenergics|EPINEPHRINE]] 1:10,000 0.3 - 0.5 mg IVP
**If no IV, [[Adrenergics|EPINEPHRINE]] 1:1,000 0.3 - 0.5 mg SQ
* Fluid boluses in increments of 200 - 300 ml, to titrate systolic BP > 90 mm Hg
* May repeat [[Adrenergics|EPINEPHRINE]] 1:10,000 0.3 mg IVP every 10 min or [[Adrenergics|EPINEPHRINE]] 1:1,000 - 0.3 to 0.5 mg SQ every 30 min. Contact Medical Control at ER for order if time permits

Latest revision as of 14:29, 24 April 2020

Section 5 -MEDICAL

5.02 ALLERGIC REACTION / ANAPHYLACTIC SHOCK

  • For pediatric patients, refer to Handtevy
  • Reactions tend to be more severe if they occur immediately after contact or ingestion
  • Exam airway for edema

INITIAL MEDICAL CARE (2.01)

  • Provide OXYGEN or assist ventilations as appropriate for patient condition.
  • Establish IV or administer medications into extremity without bite or injection of allergen.
  • Administer medications into areas without hives (urticaria)

MILD (urticaria, no respiratory involvement)


MODERATE (mild respiratory involvement)

+/-

  • IPRATROPIUM (ATROVENT) 0.5mg via updraft


SEVERE (stridor / airway involvement)

+/-

ANAPHYLACTIC SHOCK / CARDIAC ARREST IMMINENT

  • EPINEPHRINE 0.1mg/1ml 0.5-1mg IVP (may repeat q 10 min)
  • IV NS BOLUS 500-1000ml (maintain systolic BP > 90mm HG)
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