PEDS
Allergic Reaction or Anaphylaxis
Algorithm
Allergic Reaction: Mild (rash, urticaria, stable vital signs):
→ Pulse oximetry, if SPO2 less than 95%
▼
High flow oxygen by mask as tolerated
Allergic Reaction: Moderate (facial/cervical angio-edema, SOB or wheezing):
→ Pulse oximetry, if oxygen saturation less than 95%
►High flow oxygen by mask as tolerated
▼
►Epinephrine 0.01 mg/kg IM (1 mg/mL) (maximum 0.3 mg)
►Diphenhydramine: 1 mg/kg IM / IV (maximum 50 mg), may repeat once in 3 min
→ If wheezing present:
►Albuterol: 5 mg (6 mL) nebulize continuous as tolerated
Anaphylaxis: Severe (hypotension, severe wheezing, SOB, impending airway obstruction):
→ Pulse oximetry, if oxygen saturation less than 95%
► High flow oxygen by mask as tolerated
▼
Epinephrine IV preferred if established, if not use Epinephrine IM
►Epinephrine 0.01 mg/kg IM (1 mg/mL) (maximum 0.3mg)
or
►Epinephrine 0.01 mg/kg slow IV/ IO (0.1 mg/mL) (IV access is preferred, max 0.3 mg)
▼
►Diphenhydramine: 1 mg/kg IV/ IO (max 50 mg), may repeat once in 3 min
▼
→ If wheezing present:
►Albuterol 5 mg (6 mL) nebulize continuous as tolerated
▼
If signs or symptoms of poor perfusion:
► Establish IV/IO access
►Infuse 20 mL/kg NS bolus (Max 250 mL) may repeat twice to maintain perfusion
→ ALS escort to nearest PRC or BHO if no response to therapy or condition worsens
If cardiac arrest occurs, treat using cardiac arrest standing orders (SO-P-40)
1:10,000 = 0.1mg/mL
1:1000 = 1mg/mL