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Allergic Reaction


Inclusion Criteria: Patients presenting with rash, hives, shortness of breath, or other signs and symptoms, up to and including shock, apparently due to an allergic reaction.


          Basic Level

  1. Assess and support ABCs.
  2. Place the patient in a position of comfort. If evidence of shock, place the patient supine with the feet elevated.
  3. Isolate the patient from the source of the allergen, if possible.
  4. Administer oxygen, as needed to maintain an SpO2 of at least 96%
  5. Assess breath sounds. If wheezing is present and paramedics are not present at the scene, EMT-Basics may administer epinephrine via thepatient’s own autoinjector, if available. During injection, remember to hold the autoinjector against the patient’s skin for at least 10 seconds. EMT-Basics may not administer additional autoinjector doses of epinephrine without BioTel authorization.


    Advanced Level

  6. Apply ECG and ETCO2 monitors if respiratory distress or shock is present or develops.
  7. Consider establishing IV access at a TKO rate or use a saline lock.
  8. Conditions:

    If localized reaction only (hives) administer:
    Adult
    • diphenhydramine 25 mg - 50 mg IM or IV
    		 Pediatric
    • diphenhydramine 1 mg/kg-2 mg/kg IM or IV

    If dyspnea without shock, hypoperfusion, or critical airway, administer:
    Adult
    • 1:1,000 epinephrine 0.3 mg-0.5 mg SQ (unless given previously by autoinjector)
    • diphenhydramine 25 mg – 50 mg IM or IV
    		 Pediatric
    • 1:1,000 epinephrine 0.01 mg/kg SQ (unless given previously by autoinjector) (max dose of 0.3mg)
    • diphenhydramine 1 mg/kg-2 mg/kg IM or IV

    For bronchospasm unresponsive after 5 minutes to epinephrine SQ and diphenhydramine, administer albuterol 2.5 mg via nebulizer. May repeat for a total of three (3) doses.

    If shock, severe hypoperfusion, critical airway or SBP less than 90 mmHg, administer epinephrine 1:1,000 as soon as possible. Do not delay epinephrine administration while attempting IV/IO access.
    Adult
    • 1:1,000 epinephrine 0.3 mg-0.5 mg SQ. If the patient is responding but needs additional dose, repeat single dose every 20 minutes up to three doses (count autoinjector doses as part of the three)
    • 250 mL normal saline fluid boluses as needed (up to 1,000 mL) to maintain a systolic pressure of 90 mmHg
    • diphenhydramine 25 mg - 50 mg IV/IO
    • methylprednisolone 60 mg - 125 mg IVP (optional medication)
    • If no response to the first SQ epinephrine and fluid bolus within 10 minutes, administer 1:10,000 epinephrine 0.1 mg - 0.2 mg IV or IO VERY SLOWLY (over 1 minute)
    		 Pediatric
    • 1:1,000 epinephrine 0.01 mg/kg SQ (max dose of 0.3mg)
    • 20 mL/kg normal saline fluid bolus
    • diphenhydramine 1 mg/kg-2 mg/kg IM or IV/IO
    • If no response to SQ epinephrine and fluid bolus within 10 minutes, administer 1:10,000 Epinephrine 0.01 mg/kg IV or IO

    For bronchospasm unresponsive after 5 minutes to epinephrine SQ and diphenhydramine, administer albuterol 2.5 mg via nebulizer. May repeat for a total of three (3) doses.


  9. Monitor vital signs and transport
  10. For additional patient care considerations not covered under standing orders, consult BioTel.


 

 

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