Difference between revisions of "Allergic Reaction Anaphylactic Shock"

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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 [[Oxygen|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====
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=== <span style="color: green;">MILD (urticaria, no respiratory involvement)</span> ===
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* If wheezing present:
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*[[Diphenhydramine|DIPHENHYDRAMINE (BENADRYL)]] 25-50mg IM/IVP
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**[[Bronchodilators|ALBUTEROL (PROVENTIL)]] 2.5 mg via updraft. Monitor heart rate. (Consider [[Bronchodilators|IPRATROPIUM BROMIDE (ATROVENT)]] 0.5mg/2.5cc via updraft)
+
*Consider [[Solu-Medrol|METHYLPREDNISOLONE (SOLU-MEDROL)]] 125mg IM/IVP if the speed of reaction appears rapid.  
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* 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
+
*[[Diphenhydramine|DIPHENHYDRAMINE (BENADRYL)]] 25-50mg IM/IVP  
−
***Refer to Handtevy System
+
*[[Solu-Medrol|METHYLPREDNISOLONE (SOLU-MEDROL)]] 125mg IVP/IM
−
* If mild/ moderate reaction:
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*[[Pepcid|FAMOTIDINE (PEPCID)]] 20mg/50ml IVPB
−
**Administer [[Antihistamines|FAMOTIDINE (PEPCID)]] 20 mg/50 ml IVPB at wide open rate
+
*[[Epinephrine|EPINEPHRINE]] UPDRAFT (1mg/1ml + 2ml NS)
−
* Moderate Reaction:
+
 
−
**Administer [[Antihistamines|FAMOTIDINE (PEPCID)]] 20 mg/50 ml IVPB at wide open rate
+
*[[Albuterol|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|EPINEPHRINE]] 1mg/1ml  0.3-0.5mg IM (may repeat q 10min)
 +
*[[Diphenhydramine|DIPHENHYDRAMINE (BENADRYL)]] 50mg IM/IVP
 +
*[[Solu-Medrol|METHYLPREDNISOLONE (SOLU-MEDROL)]] 125mg IM/IVP
 +
*[[Pepcid|FAMOTIDINE (PEPCID)]] 20mg/50ml IVPB
 +
*IV NS BOLUS 500-1000ml (maintain systolic BP > 90mm HG)
 +
*[[Albuterol|ALBUTEROL (PROVENTIL)]] 2.5mg via updraft
 +
+/-
 +
*[[Atrovent|IPRATROPIUM BROMIDE [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|EPINEPHRINE]] 0.1mg/1ml  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]]

Latest revision as of 05:46, 13 November 2020

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)


MODERATE (mild respiratory involvement)

+/-

  • IPRATROPIUM (ATROVENT) 0.5mg via updraft


SEVERE (stridor / airway involvement)

+/-

ANAPHYLACTIC SHOCK / CARDIAC ARREST IMMINENT

  • EPINEPHRINE 0.1mg/1ml 0.5-1mg IVP (may repeat q 10 min)
  • IV NS BOLUS 500-1000ml (maintain systolic BP > 90mm HG)
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