Paramedic Kardex

The is a quick reference ONLY to the Policies and Guidelines set by OCEMSA.
All specific Treatment Guidelines questions should be directed to the OCEMSA Website.
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%
▼
High flow oxygen by mask as tolerated
Allergic Reaction Includes:
(facial/cervical angio-edema):
▼
►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)
▼
►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)
▼
→ Pulse oximetry, if SPO2 less than 95%
►Oxygen by mask or nasal cannula
→ ALS Escort
Allergic Reaction Includes:
(wheezing or hypoxia - SPO2 < 95%):
▼
► High flow oxygen by mask as tolerated.
▼
►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)
▼
►Oxygen by mask or nasal cannula
►Albuterol 5mg (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)
→ 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