Page 91 - PJ MED OPS Handbook 8th Ed

Anaphylactic Reaction

SPECIAL CONSIDERATIONS:
1. Acute, widely distributed form of shock (vasodilation) which occurs within minutes of
exposure to allergens.
2. Primary causes include insect envenomation, medications, and food allergies.
3. Death can result from airway compromise, inability to ventilate, or cardiovascular collapse.
4. The Medic’s responsibility is to know if members in the unit have such a condition. More-
over, the Medic must also ensure that the member has some sort of anaphylaxis kit and
is trained to use it.
5. Consider localized allergic reaction. Anaphylaxis is a life-threatening emergency.

Signs and Symptoms:
1. Wheezing (bronchospasm)
2. Dyspnea
3. Stridor (laryngeal edema)
4. Angioedema (swollen, red face)
5. Urticaria (hives, itching)
6. Hypotension
7. Tachycardia
Management:
FOR PATIENTS WITH SIGNS AND SYMPTOMS OF AIRWAY INVOLVEMENT AND/OR CIRCULATORY
COLLAPSE:
1. Epinephrine is the mainstay of therapy.
a. Administer Epi-Pen
b. OR epinephrine 0.5mg (0.5mL of 1:1000 IM). DO NOT USE INTRAVENOUSLY.
c. Repeat epinephrine q5min PRN
2. Oxygen with pulse oximetry monitoring
3. If severe respiratory distress exists, aggressive airway management with bag-valve-mask and
airway adjuncts (oral and nasopharyngeal airways). Intubate early if no response to epinephrine.
4. IV normal saline TKO (saline lock)
a. Administer 1–2 liters crystalloid (LR or NS) bolus for hypotension
b. Titrate to establish systolic blood pressure >90mmHg or palpable radial pulse if BP cuff not
available.
5. Diphenhydramine (Benadryl) 50mg IV/IM/PO/SL
6. Dexamethasone (Decadron) 10mg IV/IM/PO
7. If wheezing is present after epinephrine administration, consider albuterol (Ventolin), 2–3 puffs
q5min, repeat up to 3 times. The metered dose inhaler works best when used with a spacer (e.g.,
rolled up piece of paper, cardboard from toilet paper roll, etc.).
8. Famotidine (Pepcid) 20mg PO bid

DISPOSITION:
1. Urgent evacuation.

Chapter 8. Tactical Medical Emergency Protocols (TMEPs) n 89