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Anaphylaxis / Allergic Reaction 3.0

All Providers

  • Focused history and physical exam
  • Cardiac monitor, pulse oximetry, consider ETCO2
  • Treatment Plan
    • -Eliminate source of exposure
    • -Maintain Airway
    • -Apply cold pack to bite or sting
    • -Monitor for hypotension
  • Treat and transport in position of comfort
Key Considerations
  • Non-anaphylactic Allergic Reaction: one organ system that does NOT involve the airway
  • Anaphylactic Reaction: more severe and is characterized by acute onset involving:
    • *Hypotension after exposure
    • *Two or more organ systems
      • -Skin or mucosal involvement
      • -Respiratory compromise (dyspnea, wheezing, stridor, hypoxemia)
      • -Persistent GI symptoms (vomiting, abdominal pain)
    • Do not delay administering epinephrine.
      • Give IM epinephrine as soon as the diagnosis of anaphylaxis has been established.

ADULT (>25 kg / 55 lbs)

EMT
  • Give or assist patient with epinephrine Autoinjector (0.3 cc IM) for anaphylaxis)
  • OR administer epinephrine (1:1000) 0.3 cc IM
  • Assist patient with using own albuterol inhaler for wheezing
  • O2 as needed to maintain SaO2 above 93%
  • Consider advanced airway
  • If wheezing or stridor is present:
    • albuterol MDI with spacer: 4 puffs q 5 minutes until symptoms improve
      • OR
    • -Nebulized albuterol 2.5 mg (3 ml of 0.083%) q 10 minutes until symptoms improve
      run oxygen for nebulizer at 8lpm
AEMT
  • Epinephrine (1:1000) 0.3 cc IM
    • may repeat every 10 minutes until symptoms improved
  • Vascular access and fluid therapy per Fluid Therapy Guideline
  • Diphenhydramine 50 mg IV/IO/IM for allergic reaction with itching/urticarial
Paramedic
  • Epinephrine (1:10,000) 1 mg IV/IO may be used for severe or persistent hypotension, despite multiple doses of IM epinephrine
  • May repeat in 5 minutes if hypotension persists
  • ℗ Epinephrine (1:10,000) 2-10 mcg/min IV/IO infusion for hypoperfusion. Titrate to maintain MAP >60 mmHG.

Pediatric (<25 kg / 55 lbs)

EMT
  • Give or assist patient with epinephrine Autoinjector (JR or 0.15 cc IM) for severe respiratory distress anaphylaxis) -if > 25 Kg (55 lbs), use adult autoinjector
  • Assist patient with using own albuterol inhaler for wheezing
  • O2 as needed to maintain SaO2 above 90%
AEMT
  • Epinephrine (1:1000) 0.15 cc IM
    • may repeat every 10 minutes until symptoms improved
    • - If > 25 Kg, then use 0.3 cc IM
  • Vascular access and fluid therapy per Fluid Therapy Guideline
  • Diphenhydramine 1mg/kg to mx of 50mg IV/IO/IM for allergic reaction with itching/urticarial
  • if wheezing present:
    • Albuterol MDI with spacer: 2 puffs q 5minutes until symptoms improve
    • OR
    • Nebulized Albuterol 2.5 mg (3 ml of 0.083%) q 10 minutes until symptoms improve -run oxygen for nebulizer at 8 lpm
Paramedic
  • Epinephrine (1:10,000) 0.01mg/kg IV/IO may be used for severe or persistent hypotension, despite multiple doses of IM epinephrine
  • May repeat in 5 minutes if hypotension persists
  • ℗ Epinephrine (1:10,000) 0.1mcg/kg/min IV/IO infusion for hypoperfusion. Titrate to maintain SBP >70 + (age in years X 2)mmHg