BLS

 

  1. Begin Initial Medical Care.
  2.  

  3. Follow Airway Management protocol.
  4.  

  5. Follow Oxygen Administration protocol.
  6.  

  7. Call for an ALS unit if patient has wheezing, stridor, or shows other signs of respiratory distress or nausea/vomiting.
  8.  

  9. If patient has a prescribed Epi auto-injector and displays signs of anaphylaxis, assist patient with or administer one dose of the patient’s own Epi auto-injector.
  10.  

  11. F. If patient does not have a prescribed Epi-auto injector and displays signs of anaphylaxis, administer epinephrine 1 mg/mL (1:1000) at the following dose and route:
  12.  

    1. Adult (25kg or more) 0.3 mg IM in the anterolateral thigh

     

  13. If signs of anaphylaxis and hypoperfusion persist following the first dose of epinephrine, additional IM epinephrine can be repeated every 5-15 minutes at above noted doses.

 

ALS
IF suspected anaphylaxis, proceed directly to epinephrine administration

 

  1. Establish a saline lock or an IV with 0.9% NaCl or LR. Titrate fluids to a SBP of 90 mmHg.
  2.  

  3. Apply cardiac monitor.
  4.  

  5. Medicate according to signs/symptoms as below.

 

Isolated Itchy Rash/Hives

 

    Administer Diphenyhdramine 25-50 mg IV or IM

 

2 or more body systems involved, such as Rash/Hives & Wheezing

 

  1. Administer 0.3 mg Epinephrine 1:1,000 IM.
  2.  

  3. If there is dyspnea or wheezing, administer 2.5 mg nebulized Albuterol at a flow sufficient to produce of mist.
  4.  

  5. Administer Diphenhydramine 25-50 mg IV or IM.

 

Stridor &/or Hypotension

 

  1. Administer 0.3 mg Epinephrine 1:1,000 IM.
  2.  

  3. Administer 2.5 mg nebulized Albuterol.
  4.  

  5. Administer Diphenhydramine 25-50 mg IV or IM.
  6.  

  7. If condition remains unchanged or worsens after 3 minutes, administer additional dose of 0.3mg Epinephrine 1:1,000 IM.
  8.  

  9. If after 3 minutes and second dose of epinephrine condition remains unchanged, mix and infuse epinephrine drip at 5mcg/min. Contact medical control if need for titration.

 

Epinephrine drip: Inject 1mL of epinephrine 1:1000 (also known as epinephrine 1 mg/ml for anaphylaxis) into a 1-liter saline or LR bag and mix.

 

This yields a final medication concentration of 1mcg epinephrine / 1mL fluid. You must label the medication “Epi Drip: 1mcg/mL”

 

Use of a 20 gtt drip set is preferred. A 20 gtt drip set allows for:
Adult dosing: Drip rate of 100 drops/min yields drug infusion rate of 5 mcg/min.
Drip rate can be easily calculated by counting number of drops over 15 seconds then multiply by 4.