Allergic Reaction Anaphylactic Shock

Section 5 -MEDICAL

5.02 ALLERGIC REACTION / ANAPHYLACTIC SHOCK

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)

ALLERGIC REACTION:

• 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
    • Refer to Handtevy System
• 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 (1mg/ml) 0.3mg SQ
• Cardiac Arrest or Cardiopulmonary Arrest Imminent:
  • EPINEPHRINE 1:10,000 (0.1mg/ml) 0.3mg IVP (instead of 1:1,000)
  • Consider all appropriate therapeutic and/or pharmacologic modalities to correct the condition.

ANAPHYLACTIC SHOCK:

• 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