PEDS

Allergic Reaction or Anaphylaxis

Algorithm

New UPDATED 10/1/2019

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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

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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

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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

Link - SO-P-60