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Medical

Pediatric ALLERGIC REACTION

Signs and Symptoms: Differential Diagnosis:
• Itching or Hives • Urticaria (rash only)
• Cough/Wheeze/Resp. Distress • Anaphylaxis (2 or more systems)
• Chest/Throat tightness • Shock (other than anaphylactic)
• Difficulty Swallowing • Angioedema
• Hypotension or Shock • Aspiration/Airway Obstruction
• Edema • Asthma or COPD
• Nausea/Vomiting • Pulmonary Edema/CHF
Universal Patient Care Guideline
Continued from: O2 (if Hypoxemic) Shock/Unresponsive
Tactical Evacuation Guideline IV/IO Guideline or
Cardiac Monitor (ASAP) Respiratory Distress/Failure
Hives / Rash Only
Emergency Airway
No Resp. Complaint ASSESSMENT YES Intervention Needed?
Pediatric NO
n
3
O
K
P
e
0

g
Diphenhydramine Airway EpiPen (Jr for <<30Kg OR R
1mg/kg IV/IO/IM/PO Epinephrine 1:1,000
Methylprednisolone 0.01mg/kg IM (max 0.3mg)
2mg/kg IV/IO
Epinephrine
Reassess q5min IM: 0.01mg/kg (0.01mL/kg 20mL/kg IVF Bolus if not
previously started
of 1:1000) or EpiPen Jr.®
Pediatric Bradycardia with Pulse IV Infusion 0.01-0.03 Albuterol 90mcg 2 puffs MDI
and Poor Perfusion mcg/kg/min or 2.5mg via nebulizer
(increase PRN if hypotensive) Diphenhydramine
Pediatric Cardiac Arrest Worse 1mg/kg IV/IO/IM/PO
or
Unstable Methylprednisolone
Pediatric Tachycardia with Pulse Contact Medical Control 2mg/kg IV
and Poor Perfusion
Reassess Patient
Pediatric Tachycardia with Pulse Improved
and Adequate Perfusion YES Arrhythmia? Continuous Monitoring
NO
Pediatric Hypotension Pediatric Resp. Distress
Pearls:
• Epinephrine can precipitate dysrhythmias/ischemia – all patients should be on monitors and have
12-lead ECG.
• The shorter the interval from contact to symptoms, the more severe the reaction.

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