Allergic Reaction Anaphylactic Shock

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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)

  • DIPHENHYRADMINE (BENADRYL) 25-50mg IM/IVP
  • Consider METHYLPREDNISOLONE (SOLU-MEDROL) 125mg IM/IVP if the speed of reaction appears rapid.


MODERATE (mild respiratory involvement)

  • DIPHENHYRADMINE (BENADRYL) 25-50mg IM/IVP
  • METHYLPREDNISOLONE (SOLU-MEDROL) 125mg IVP/IM
  • FAMOTIDINE (PEPCID) 20mg/50ml IVPB
  • EPINEPHRINE UPDRAFT (1:1,000 + 2ml NS)
  • ALBUTEROL (PROVENTIL) 2.5mg via updraft

+/-

  • IPRATROPIUM (ATROVENT) 0.5mg via updraft


SEVERE (stridor / airway involvement)

  • EPINEPHRINE 1:1,000 0.3-0.5mg IM (may repeat q 10min)
  • DIPHENHYRADMINE (BENADRYL) 50mg IM/IVP
  • METHYLPREDNISOLONE (SOLU-MEDROL) 125mg IM/IVP
  • FAMOTIDINE (PEPCID) 20mg/50ml IVPB
  • IV NS BOLUS 500-1000ml (maintain systolic BP > 90mm HG)
  • ALBUTEROL (PROVENTIL) 2.5mg via updraft

+/-

  • IPRATROPIUM (ATROVENT) 0.5mg via updraft

ANAPHYLACTIC SHOCK / CARDIAC ARREST IMMINENT

  • EPINEPHRINE 1:10,000 0.5-1mg IVP (may repeat q 10 min)
  • IV NS BOLUS 500-1000ml (maintain systolic BP > 90mm HG)
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