ANAPHYLACTIC REACTION

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.

FIRST RESPONDER AND BASIC PRE-HOSPITAL MANAGEMENT1.

1. Initial Management - Assess airway, breathing and circulation and manage as indicated.
2. Rapidly transport the patient to an appropriate medical facility. Consider ILS or ALS intercept.
3. Focused H&P - History, physical exam, vital signs.
4. Remove injection mechanism if still present and treat wound.
5. If patient exhibits respiratory distress:

• With on line medical control, administer EPINEPHRINE 1:1000 [0.3mg] SQ or IM from a pre-measured, pre-filled device or SQ using 0.3 ml syringe. (FIRST RESPONDER: AUTO-INJECTOR ONLY). If on line medical control is not available, administration is allowed under off line medical control if the licensed provider is working under medical direction using approved written medical protocols. FIRST RESPONDERS AND BASICS MAY NOT ADMINISTER EPINEPHRINE 1:1000 TO PEDIATRIC PATIENTS.
• Consider administration of nebulized ALBUTEROL [2.5 – 5.0 mg] with or without IPRATROPIUM [0.5 mg]

 INTERMEDIATE and PARAMEDIC PRE-HOSPITAL MANAGEMENT
6. Treatment should continue at the intermediate and paramedic level as follows:

• Adult - administer EPINEPHRINE 1:1000 [0.3mg] SQ. May be repeated once in 10 minutes if hypotension or severe SOB is still present.
• Pediatric - administer EPINEPHRINE 1:1000 [0.01 cc/kg (0.01 mg/kg)] SQ.
• Adult - administer DIPHENHYDRAMINE [20-50 mg] slow IVP at a rate of 1ml/min. or deep IM.
• Pediatric - administer DIPHENHYDRAMINE [1mg/kg] slow IVP or deep IM with a max dose of 50 mg.
• En-route, initiate a large bore IV of an isotonic solution titrate to maintain adequate vital signs.
• If there is a marked decrease in BP or the patient is displaying signs & symptoms of respiratory and/or cardiovascular collapse (paramedic only):
• Adult - administer EPINEPHRINE 1:10,000 [1ml (0.1 mg)] slow IVP and initiate
  epinephrine infusion at 1.0-4.0 mcg/minute
• Pediatric - administer EPINEPHRINE 1:10,000 [0.01 mg/kg (0.1ml/kg)] IVP
• Consider methylprednisolone [125-250 mg]