Allergic Reaction Anaphylactic Shock

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)

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

MODERATE (mild respiratory involvement)

• DIPHENHYDRAMINE (BENADRYL) 25-50mg IM/IVP
• METHYLPREDNISOLONE (SOLU-MEDROL) 125mg IVP/IM
• FAMOTIDINE (PEPCID) 20mg/50ml IVPB
• EPINEPHRINE UPDRAFT (1mg/1ml (1:1000) + 2ml NS)

• ALBUTEROL (PROVENTIL) 2.5mg via updraft

+/-

• IPRATROPIUM (ATROVENT) 0.5mg via updraft

SEVERE (stridor / airway involvement)

• EPINEPHRINE 1mg/1ml 0.3-0.5mg IM (may repeat q 10min)
• DIPHENHYDRAMINE (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 BROMIDE [ATROVENT] 0.5mg via updraft

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)