Anaphylaxis Protocol

Emergency treatment for severe allergic reaction

CRITICAL - TIME SENSITIVE

IMMEDIATE ACTION REQUIRED

EPINEPHRINE is the FIRST and MOST IMPORTANT treatment!

Do NOT delay epinephrine administration. There are NO absolute contraindications to epinephrine in anaphylaxis.

Immediate Actions

Remove/stop trigger if possiblePosition patient supine (or sitting if dyspneic)GIVE EPINEPHRINE IM NOWHigh-flow oxygen (10-15 L/min)Establish large bore IV accessIV fluids (1-2L NS rapid infusion)Continuous monitoring (ECG, BP, SpO2)

Epinephrine Doses Given:

Signs & Symptoms

skin

•Urticaria (hives)
•Angioedema
•Flushing
•Pruritus

respiratory

•Dyspnea
•Wheezing
•Stridor
•Hypoxia
•Respiratory arrest

cardiovascular

•Hypotension
•Tachycardia
•Weak pulse
•Dizziness
•Syncope
•Cardiac arrest

gastrointestinal

•Nausea
•Vomiting
•Diarrhea
•Abdominal cramps

neurological

•Anxiety
•Sense of impending doom
•Confusion
•Loss of consciousness

Medication Dosing

Epinephrine

FIRST LINE

Adult: 0.3-0.5 mg IM (Adult)

Peds: 0.01 mg/kg IM (Max 0.5mg)

Route: Intramuscular (lateral thigh)

Frequency: Repeat every 5-15 min as needed

Diphenhydramine

SECOND LINE

Adult: 25-50 mg IV/IM

Peds: 1-2 mg/kg (Max 50mg)

Route: IV preferred

Frequency: Every 4-6 hours

Methylprednisolone

SECOND LINE

Adult: 125 mg IV

Peds: 1-2 mg/kg (Max 125mg)

Route: IV

Frequency: Single dose

Albuterol

For bronchospasm

Adult: 2.5-5 mg nebulized

Peds: 2.5 mg nebulized

Route: Inhalation

Frequency: Every 20 min as needed

Refractory Anaphylaxis

If no response to IM epinephrine:

•Start epinephrine IV infusion (0.1-1 mcg/kg/min)
•Consider glucagon 1-5 mg IV for patients on beta-blockers
•Aggressive fluid resuscitation (up to 4-6L may be needed)
•Consider vasopressin for refractory hypotension

Disposition & Follow-up

•Observe minimum 4-6 hours after symptom resolution
•Admit if: severe reaction, refractory symptoms, or biphasic reaction
•Prescribe epinephrine auto-injector (2 doses)
•Refer to allergist for testing and follow-up
•Educate on trigger avoidance and action plan

Biphasic Reaction Warning

Up to 20% of patients may experience a biphasic reaction with return of symptoms 1-72 hours (typically 8-10 hours) after initial symptom resolution. Extended observation or admission should be considered for severe reactions.