Pediatric: Anaphylactic Shock / Allergic Reaction

 

History:

 

  • Onset and location
  • Insect sting/bite
  • Food allergy/exposure
  • Medication allergy/exposure
  • New clothing, soap, detergent
  • Past history/reactions
  • Medication history
  • Antipsychotics
  • Antiemetics

 

Significant Findings:

 

  • Itching/hives
  • Coughing/wheezing/respiratory distress
  • Chest/throat constriction
  • Difficulty swallowing
  • Hypotension/shock
  • Edema
  • Dystonic/extrapyramidal reaction
  • Involuntary muscle contractions of the face, chest, neck, back, and pelvis
  • Deviated pupils
  • Swollen tongue

 

Differential:

 

  • Urticaria (rash only)
  • Anaphylaxis (systemic effect)
  • Shock (vascular effect)
  • Angioedema (drug induced)
  • Aspiration/airway obstruction
  • Vasovagal event
  • Asthma
  • Congenital heart disease
  • Infection
  • Pneumonia
  • Croup
  • Epiglottitis

 

 TREATMENT

 

 

 

  • Oxygen

 

 

 

  • 12-Lead EKG

 

 

 

  • Initiate IV/IO

 

 

 

 

Hives/rash only; No respiratory component ?

 

    • Notify receiving facility or contact Medical Control

 

Wheezing/airway involvement/ hypotension/difficulty swallowing/ swollen tongue or lips ?

 

 

 

 

 

 

    • Normal Saline 20 mL/kg IV; max 60 mL/kg or 1,000 mL to reduce signs of hypotension

 

 

 

 

Respiratory distress ?

 

  • Yes

 

 

 

 

    • Notify receiving facility or contact Medical Control

 

PEARLS:

 

  • Common medication groups that cause dystonic reactions include:

 

    •  Antipsychotics:

 

      • Zyprexa (Olanzapine),
      • Haloperidol (Haldol),
      • Alprazolam (Xanax),
      • Fluphenazine (Prolixin),
      • Thorazine (Chlorpromazine),
      • Ziprasidone (Geodon)

 

    • Antiemetics:

 

      • Compazine (Prochlorperazine),
      • Promethazine (Phenergan),
      • Hydroxyzine (Vistaril),
      • Metoclopramide (Reglan).

 

 

 

  • If the patient is hemodynamically unstable, request an order of Epinephrine 1:10,000 0.01 mg/kg IV/IO; max 0.3 mg. (Medical Control)

NREMR

National Registry Emergency Medical Responder

NREMT

National Registry Emergency Medical Technician

NREMT-I

National Registry EMT-Intermediate

NRP

National Registry Paramedic

NRAEMT

National Registry Advance Emergency Technician

NREMT-I

National Registry EMT-Intermediate

NRP

National Registry Paramedic

NRAEMT

National Registry Advance Emergency Technician

OLMC

Online Medical Control - Contact Medical Control