Paramedic Kardex

ADULT

Allergic Reaction or Anaphylaxis

Algorithm

New UPDATED 4/1/2019

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Standing Orders:  Allergic reactions can be mild or severe (anaphylaxis), treat based on the following assessment findings:

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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 0.5 mg IM Lateral Thigh area (1 mg/mL), once

(Do not administer if history of cardiac disease or Epi pen given prior to arrival)

▼

►Diphenhydramine 50 mg IM / IV, once

(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 0.5 mg IM Lateral Thigh area (1 mg/mL), may repeat twice (every 5 min)

(If Epi pen given PTA, consider that the first dose)

▼

→ Pulse oximetry, if SPO2 less than 95%

►Oxygen by mask or nasal cannula

►Albuterol 5mg (6 mL) nebulize continuous as tolerated
▼

►Diphenhydramine 50 mg IV / IM, once
(Do not administer if given prior to arrival)

→ ALS Escort

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Allergic Reaction Includes:  

(hypotension, respiratory distress, impending airway obstruction) (BHC)

▼

► High flow oxygen by mask as tolerated

▼

►Epinephrine 0.5 mg IM Lateral Thigh area (1 mg/mL)

→ Establish IV/IO access

▼

►Normal Saline, infuse 250 mL IV/IO

(Repeat up to 1 liter max to maintain adequate perfusion)

▼

►Epinephrine 0.5 mg IM Lateral Thigh area (1 mg/mL) or Epinephrine 0.3 mg IV/IO, may repeat once in 5 min

(Total of 2 doses of Epi can be given before Base Contact)
▼
►Diphenhydramine 50 mg IV / IO / IM, once

(Do not administer if given prior to arrival)

▼

→ Pulse oximetry, if SPO2 less than 95%

►Oxygen by mask or nasal cannula

►Albuterol 5mg (6 mL) nebulize continuous as tolerate

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→ ALS escort to nearest appropriate PRC; Base Hospital Contact if no response to therapy or condition worsens

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1:10,000 = 0.1mg / 1mL

1:1000 = 1mg / 1mL​