ANAPHYLACTIC REACTION
ALL LEVELS
DESIGNATION OF CONDITION
Signs and symptoms may include any one or all of the following: wheezing associated with bronchoconstriction and/or stridor associated with upper airway edema, tachycardia, tachypnea, dyspnea, diminishing lung sounds, diaphoresis, tripod positioning, facial swelling, hives, shock and perhaps a history of severe allergies. Respiratory involvement may or may not occur in all cases of anaphylaxis. Be aware of “silent chest” presentation in cases of severe respiratory distress associated with poor air exchange.
EMPHASIS ON PATIENT CARE
Maintenance of airway, adequate oxygenation, adequate perfusion
1. Primary Management - Assess ABC’s and manage as indicated.
2. Rapidly transport the patient to an appropriate medical facility. Consider AEMT or ALS intercept.
3. Secondary Management - History, physical exam, vital signs
4. Remove injection mechanism if still present and treat wound.
5. If patient exhibits respiratory distress:
a. Administer EPINEPHRINE 1:1000 [0.3mg or 0.3 ml.] IM from a pre-measured, pre-filled device or IM using 0.3 ml. syringe with 1 1/4 inch needle to anterolateral thigh. If needle length does not allow IM injection administer SQ. Pediatric (<25 kg.) 0.15 ml. IM as above.
b. If available, consider administration of pre-measured inhalation device.
c. Consider administration of ALBUTEROL [2.5 - 5 mg] by nebulizer or ALBUTEROL/IPRATROPIUM combination by nebulizer.
NOTE: EMT-Basics may not administer Epinephrine 1:1000 to PEDIATRIC patients weighing less than 10 kg without medical direction.
AEMT
Treatment should continue at the AEMT and PARAMEDIC as follows:
1. EPINEPHRINE 1:1,000 (1 mg./ml.) ADULT (over 25 kg.) 0.3 ml. IM anterolateral thigh (preferred). May give SQ. PEDIATRIC 0.15 ml. IM anterolateral thigh (preferred) or SQ. May repeat if needed q 10 minutes.
2. Adult - consider DIPHENHYDRAMINE [25-50 mg] slow IV/IO/IM.
a. PEDIATRIC - consider DIPHENHYDRAMINE [1mg/kg] slow IV/IO or deep IM with a max dose of 50 mg.
3. Consider METHYLPREDNISOLONE [125 mg] for adults, for PEDIATRICS [1mg/kg] IV/IO infusion over 5 minutes.
4. Consider DEXAMETHASONE orally as alternative to Methylprednisolone. Draw 0.6 mg./kg. (0.06 ml./kg.) from vial with TB (1 ml.) syringe. Remove needle and administer orally. Maximum dose 10 mg. (1.0 ml.) Concentration in vial should be confirmed; usual concentration is 10 mg./ml.
5. Keep in Mind that the administration of METHYLPREDNISOLONE in the field should NEVER delay transport as effects from this medication will not be apparent until hours after administration
6. In-route, initiate a large bore IV/IO of an isotonic solution titrated to maintain end organ perfusion.
Age Systolic Blood Pressure
(mm Hg)
Term neonates (0 to 28 days) < 60
Infants (1 to 12 months) < 70
Children (1 to 10 years) < 70 + (age in years x 2)
Children (> 10 years) < 90
PARAMEDIC
1. If there is a marked decrease in blood pressure or the patient is displaying signs & symptoms of respiratory and/or cardiovascular collapse
a. Adult - administer EPINEPHRINE 1:10,000 0.3-0.5 mg slow IV/IO (3.0-5.0 ml. IV/IO)
a. PEDIATRIC - administer EPINEPHRINE 1:10,000 0.01 mg/kg (0.1 ml./kg.) slow IV/IO up to 0.5 mg. (5 ml.)
b. Repeat EPINEPHRINE 1:10,000 0.3 mg IV/IO every 10 minutes if condition persists
2. Push Dose Epinephrine
a. In the patient with severe anaphylaxis who is not responding to Epinephrine and fluid resuscitation, IV Epinephrine should be administered.
b. Inject 1 mg. (1 ml.) of 1:1,000 Epinephrine into a 100 ml. bag of NS and mix well. Draw out 10 ml. giving you a concentration of 1:100,000.
c. Administer 1 mL (10mcg) each minute as needed until symptoms improve.
ALL LEVELS
DESIGNATION OF CONDITION
Signs and symptoms may include any one or all of the following: wheezing associated with bronchoconstriction and/or stridor associated with upper airway edema, tachycardia, tachypnea, dyspnea, diminishing lung sounds, diaphoresis, tripod positioning, facial swelling, hives, shock and perhaps a history of severe allergies. Respiratory involvement may or may not occur in all cases of anaphylaxis. Be aware of “silent chest” presentation in cases of severe respiratory distress associated with poor air exchange.
EMPHASIS ON PATIENT CARE
Maintenance of airway, adequate oxygenation, adequate perfusion
1. Primary Management - Assess ABC’s and manage as indicated.
2. Rapidly transport the patient to an appropriate medical facility. Consider AEMT or ALS intercept.
3. Secondary Management - History, physical exam, vital signs
4. Remove injection mechanism if still present and treat wound.
5. If patient exhibits respiratory distress:
a. Administer EPINEPHRINE 1:1000 [0.3mg or 0.3 ml.] IM from a pre-measured, pre-filled device or IM using 0.3 ml. syringe with 1 1/4 inch needle to anterolateral thigh. If needle length does not allow IM injection administer SQ. Pediatric (<25 kg.) 0.15 ml. IM as above.
b. If available, consider administration of pre-measured inhalation device.
c. Consider administration of ALBUTEROL [2.5 - 5 mg] by nebulizer or ALBUTEROL/IPRATROPIUM combination by nebulizer.
NOTE: EMT-Basics may not administer Epinephrine 1:1000 to PEDIATRIC patients weighing less than 10 kg without medical direction.
AEMT
Treatment should continue at the AEMT and PARAMEDIC as follows:
1. EPINEPHRINE 1:1,000 (1 mg./ml.) ADULT (over 25 kg.) 0.3 ml. IM anterolateral thigh (preferred). May give SQ. PEDIATRIC 0.15 ml. IM anterolateral thigh (preferred) or SQ. May repeat if needed q 10 minutes.
2. Adult - consider DIPHENHYDRAMINE [25-50 mg] slow IV/IO/IM.
a. PEDIATRIC - consider DIPHENHYDRAMINE [1mg/kg] slow IV/IO or deep IM with a max dose of 50 mg.
3. Consider METHYLPREDNISOLONE [125 mg] for adults, for PEDIATRICS [1mg/kg] IV/IO infusion over 5 minutes.
4. Consider DEXAMETHASONE orally as alternative to Methylprednisolone. Draw 0.6 mg./kg. (0.06 ml./kg.) from vial with TB (1 ml.) syringe. Remove needle and administer orally. Maximum dose 10 mg. (1.0 ml.) Concentration in vial should be confirmed; usual concentration is 10 mg./ml.
5. Keep in Mind that the administration of METHYLPREDNISOLONE in the field should NEVER delay transport as effects from this medication will not be apparent until hours after administration
6. In-route, initiate a large bore IV/IO of an isotonic solution titrated to maintain end organ perfusion.
Age Systolic Blood Pressure
(mm Hg)
Term neonates (0 to 28 days) < 60
Infants (1 to 12 months) < 70
Children (1 to 10 years) < 70 + (age in years x 2)
Children (> 10 years) < 90
PARAMEDIC
1. If there is a marked decrease in blood pressure or the patient is displaying signs & symptoms of respiratory and/or cardiovascular collapse
a. Adult - administer EPINEPHRINE 1:10,000 0.3-0.5 mg slow IV/IO (3.0-5.0 ml. IV/IO)
a. PEDIATRIC - administer EPINEPHRINE 1:10,000 0.01 mg/kg (0.1 ml./kg.) slow IV/IO up to 0.5 mg. (5 ml.)
b. Repeat EPINEPHRINE 1:10,000 0.3 mg IV/IO every 10 minutes if condition persists
2. Push Dose Epinephrine
a. In the patient with severe anaphylaxis who is not responding to Epinephrine and fluid resuscitation, IV Epinephrine should be administered.
b. Inject 1 mg. (1 ml.) of 1:1,000 Epinephrine into a 100 ml. bag of NS and mix well. Draw out 10 ml. giving you a concentration of 1:100,000.
c. Administer 1 mL (10mcg) each minute as needed until symptoms improve.