Allergic Reaction Anaphylactic Shock

Section 5 -MEDICAL

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)

If wheezing present:
- ALBUTEROL (PROVENTIL) 2.5 mg via updraft. Monitor heart rate. (Consider IPRATROPIUM BROMIDE (ATROVENT) 0.5mg/2.5cc via updraft)
If hives (urticaria) with history of systemic reaction in past: (All age ranges)
- 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:
- DIPHENHYDRAMINE (BENADRYL) oral liquid or dissolving tablet
  - For patients 2-6 year old – 6.25 mg PO
  - For Patients 6-11 year old – 12.5 mg PO
  - For Patients 12 and over – 25 mg PO
If mild/ moderate reaction:
- Administer FAMOTIDINE (PEPCID) 20 mg/50 ml IVPB at wide open rate
Moderate Reaction:
- Administer FAMOTIDINE (PEPCID) 20 mg/50 ml IVPB at wide open rate
- METHYLPREDNISOLONE (SOLU-MEDROL) 125 mg slow IVP
- EPINEPHRINE 1:1,000 0.3mg SQ
Cardiac Arrest or Cardiopulmonary Arrest Imminent:
- EPINEPHRINE 1:10,000 0.3mg IVP (instead of 1:1,000)
- Consider all appropriate therapeutic and/or pharmacologic modalities to correct the condition.

If wheezing present, ALBUTEROL (PROVENTIL) 2.5 mg via updraft
- Monitor heart rate. (Consider IPRATROPIUM BROMIDE [ATROVENT])
EPINEPHRINE 1:10,000 0.3 - 0.5 mg IVP
- If no IV, 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 EPINEPHRINE 1:10,000 0.3 mg IVP every 10 min or EPINEPHRINE 1:1,000 - 0.3 to 0.5 mg SQ every 30 min. Contact Medical Control at ER for order if time permits