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 [[Medical Gases|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: For pediatric patients, refer to Handtevy System for dosing====
=== <span style="color: green;">MILD (urticaria, no respiratory involvement)</span> ===
* If wheezing present:
*DIPHENHYRADMINE (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 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
*DIPHENHYRADMINE (BENADRYL) 25-50mg IM/IVP  
***Refer to Handtevy System
*METHYLPREDNISOLONE (SOLU-MEDROL) 125mg IVP/IM
* If mild/ moderate reaction:
*FAMOTIDINE (PEPCID) 20mg/50ml IVPB
**Administer [[Antihistamines|FAMOTIDINE (PEPCID)]] 20 mg/50 ml IVPB at wide open rate
*EPINEPHRINE UPDRAFT (1:1,000 + 2ml NS)
* Moderate Reaction:
 
**Administer [[Antihistamines|FAMOTIDINE (PEPCID)]] 20 mg/50 ml IVPB at wide open rate
*ALBUTEROL (PROVENTIL) 2.5mg via updraft
**[[Corticosteroids|METHYLPREDNISOLONE (SOLU-MEDROL)]] 125 mg slow IVP
+/-
**[[Adrenergics|EPINEPHRINE]] 1:1,000 (1mg/ml) 0.3mg SQ
*IPRATROPIUM (ATROVENT) 0.5mg via updraft
* Cardiac Arrest or Cardiopulmonary Arrest Imminent:
 
**[[Adrenergics|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.
=== <span style="color: red;">SEVERE (stridor / airway involvement) </span> ===
*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: For pediatric patients, refer to Handtevy System for dosing====
=== <span style="color: red;">ANAPHYLACTIC SHOCK / CARDIAC ARREST IMMINENT</span> ===
* If wheezing present, [[Bronchodilators|ALBUTEROL (PROVENTIL)]] 2.5 mg via updraft
*EPINEPHRINE 1:10,000   0.5-1mg IVP (may repeat q 10 min)
**Monitor heart rate. (Consider [[Bronchodilators|IPRATROPIUM BROMIDE [ATROVENT]]])
*IV NS BOLUS 500-1000ml (maintain systolic BP > 90mm HG)
* [[Adrenergics|EPINEPHRINE]] 1:10,000 (0.1 mg/ml) 0.3 - 0.5 mg IVP
**If no IV, [[Adrenergics|EPINEPHRINE]] 1:1,000 (1 mg/ml) 0.3 - 0.5 mg IM
* Fluid boluses in increments of 200 - 300 ml, to titrate systolic BP > 90 mm Hg
* May repeat [[Adrenergics|EPINEPHRINE]] 1:10,000 (0.1 mg/ml) 0.3 mg IVP every 10 min or [[Adrenergics|EPINEPHRINE]] 1:1,000 (1 mg/ml) - 0.3 to 0.5 mg IM every 10-15 min.


[[Category:Medical|0502]]
[[Category:Medical|0502]]

Revision as of 19:46, 16 March 2019

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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