PEDS
Allergic Reaction or Anaphylaxis
Algorithm
New UPDATED 10/1/2019
Standing Orders: Allergic reactions can be mild or severe (anaphylaxis), treat based on the following assessment findings:
Allergic Reaction Includes:
(rash, urticaria, and vital signs stable)
→ Pulse oximetry, if SPO2 less than 95%
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High flow oxygen by mask as tolerated
Allergic Reaction Includes:
(facial/cervical angio-edema):
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►Epinephrine 0.01 mg/kg IM Lateral Thigh area (1 mg/mL), once (Max of 0.5 mg)
(Do not administer if Epi pen given prior to arrival)
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►Diphenhydramine 1 mg/kg IM/IV/IO once, (Max of 40 mg or 0.8 mL of 50 mg solution)
(Do not administer if given prior to arrival)
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→ Pulse oximetry, if SPO2 less than 95%
►Oxygen by mask or nasal cannula
→ ALS Escort
Allergic Reaction Includes:
(wheezing or hypoxia - SPO2 < 95%):
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► High flow oxygen by mask as tolerated.
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►Epinephrine 0.01 mg/kg IM Lateral Thigh area (1 mg/mL), may repeat once (approx. 5 min) (Max dose of 0.5 mg)
(If Epi pen given PTA, consider that the first dose)
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►Oxygen by mask or nasal cannula
►Albuterol 5mg (6 mL) nebulize continuous as tolerated
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►Diphenhydramine 1 mg/kg IV/IM/IO, (Max of 40 mg or 0.8 mL of 50 mg solution)
(Do not administer if given prior to arrival)
→ ALS Escort
Allergic Reaction Includes:
(hypotension, respiratory distress, impending airway obstruction) (BHC)
▼
► High flow oxygen by mask as tolerated
▼
Epinephrine IV preferred if established, if not use Epinephrine IM
►Epinephrine 0.01 mg/kg IM Lateral Thigh area (1 mg/mL), may repeat once (approx. 5 min) (Max dose of 0.5 mg)
or
►Epinephrine: 0.01 mg/kg slow IV/ IO (0.1 mg/mL) (Max single dose of 0.3 mg)
▼
If signs or symptoms of poor perfusion:
► Establish IV/IO access
►Normal Saline: Infuse 20 mL/kg NS bolus IV / IO (Max 250 mL) may repeat twice to maintain perfusion
→ If after 5 minutes there is continued signs of respiratory distress, or impending airway obstruction
►Epinephrine: 0.01 mg/kg slow IV/ IO (0.1 mg/mL) (Max single dose of 0.3 mg)
or
►Epinephrine: 0.01 mg/kg IM Lateral Thigh area (0.1 mg/mL) (Max single dose of 0.5 mg)
▼
→ If wheezing present:
►Albuterol: 5 mg (6 mL) nebulize continuous as tolerated
▼
►Diphenhydramine 1 mg/kg IV/IM/IO, (Max of 40 mg or 0.8 mL of 50 mg solution)
(Do not administer if given prior to arrival)
▼
→ Contact a Pediatric Resource Center/Base Hospital and ALS escort as directed to CCERC or ERC
1:10,000 = 0.1mg/mL
1:1000 = 1mg/mL