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Medical

ALLERGIC REACTION

Signs and Symptoms: Differential Diagnosis:
• Itching or Hives • Urticaria (rash only)
• Cough / Wheeze / Resp. Distress • Shock (other than anaphylactic)
• Chest / Throat Tightness • Angioedema
• Difficulty Swallowing • Aspiration / Airway Obstruction
• Hypotension or Shock • Asthma or COPD
• Edema • Pulmonary Edema / CHF
• Nausea / Vomiting
Universal Patient Care Guideline
Continued from: O2 (if Hypoxemic)
Tactical Evacuation Guideline IV/IO Guideline 1 1) Shock or ↓BP
)
Cardiac Monitor (ASAP)
)
2 2) Any 2 of the following:
Hives / Rash Only Skin changes, resp S Sx’s,
ASSESSMENT angioedema, or GI S Sx’s.
NO Resp. depression
or reduced BP
Epinephrine-Pen
Or
Diphenhydramine Epinephrine 1:1000
25-50mg IV/IO/IM/PO Epinephrine IV 0.3-0.5mg IM
See “pearls” prior to use!
Methylprednisolone
125mg IV/IO (IV Push: 1-2cc every 2 min 500mL IVF if not previously
until status improving)
started
Reassess q 5 minutes If unable to mix epinephrine,
may consider repeat: Albuterol 90mcg 2 puffs MDI
Epinephrine-Pen OR
Epinephrine 1:1000 or 2.5mg via nebulizer
0.3-0.5mg IM Diphenhydramine
Bradycardia with Pulse Guideline Worse 50mg IV/IO/IM/PO
or
Unstable Methylprednisolone
Cardiac Arrest Guideline Contact Medical Control 125mg IV/IO
Reassess Patient
Tachycardia with Pulse Guideline Improved
YES Arrhythmia? Continuous Monitoring
NO
Hypotension Guideline Resp. Distress Guideline
Pearls:
• Use caution prior to giving epinephrine IV to patients >50yo, pregnant, have a history of cardiac disease, or
have HR >150. Epinephrine can precipitate dysrhythmias/ischemia – all patients should be on monitors and
have 12-lead ECG.
• Epinephrine:
o IM: 0.3-0.5mg (0.3-0.5 mL 1:1000) or EpiPen®
o IV Bolus: 100mcg over 5-10 min; mix 0.1mg (0.1mL of 1:1000 in 10mL NS, and infuse over 5-10 min)
o IV Infusion: Start at 1mcg/min; mix 1mg (1mL of 1:1000 in 500mL NS, and infuse at 0.5mL/min; titrate
as needed
• The shorter the interval from contact to symptoms, the more severe the reaction.
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