ADULT
Allergic Reaction or Anaphylaxis
Algorithm
New UPDATED 4/1/2019
Standing Orders: Allergic reactions can be mild or severe (anaphylaxis), treat based on the following assessment findings:
Allergic Reaction Includes:
(rash, urticaria, and vital signs stable):
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→ Pulse oximetry, if SPO2 less than 95%
→ High flow oxygen by mask as tolerated
Allergic Reaction Includes:
(facial/cervical angio-edema):
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►Epinephrine 0.5 mg IM Lateral Thigh area (1 mg/mL), once
(Do not administer if history of cardiac disease or Epi pen given prior to arrival)
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►Diphenhydramine 50 mg IM / IV, once
(Do not administer if given prior to arrival)
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→ Pulse oximetry, if SPO2 less than 95%
►Oxygen by mask or nasal cannula
→ ALS Escort
Allergic Reaction Includes:
(wheezing or hypoxia - SPO2 < 95%):
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► High flow oxygen by mask as tolerated.
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►Epinephrine 0.5 mg IM Lateral Thigh area (1 mg/mL), may repeat twice (every 5 min)
(If Epi pen given PTA, consider that the first dose)
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→ Pulse oximetry, if SPO2 less than 95%
►Oxygen by mask or nasal cannula
►Albuterol 5mg (6 mL) nebulize continuous as tolerated
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►Diphenhydramine 50 mg IV / IM, once
(Do not administer if given prior to arrival)
→ ALS Escort
Allergic Reaction Includes:
(hypotension, respiratory distress, impending airway obstruction) (BHC)
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► High flow oxygen by mask as tolerated
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►Epinephrine 0.5 mg IM Lateral Thigh area (1 mg/mL)
→ Establish IV/IO access
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►Normal Saline, infuse 250 mL IV/IO
(Repeat up to 1 liter max to maintain adequate perfusion)
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►Epinephrine 0.5 mg IM Lateral Thigh area (1 mg/mL) or Epinephrine 0.3 mg IV/IO, may repeat once in 5 min
(Total of 2 doses of Epi can be given before Base Contact)
▼
►Diphenhydramine 50 mg IV / IO / IM, once
(Do not administer if given prior to arrival)
▼
→ Pulse oximetry, if SPO2 less than 95%
►Oxygen by mask or nasal cannula
►Albuterol 5mg (6 mL) nebulize continuous as tolerate
→ ALS escort to nearest appropriate PRC; Base Hospital Contact if no response to therapy or condition worsens
1:10,000 = 0.1mg / 1mL
1:1000 = 1mg / 1mL