Pediatric: Anaphylactic Shock / Allergic or Dystonic Reation
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
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 ?
-
- Notify receiving facility or contact Medical Control
PEARLS:
- Common medication groups that cause dystonic reactions include:
-
-
- Zyprexa (Olanzapine),
- Haloperidol (Haldol),
- Alprazolam (Xanax),
- Fluphenazine (Prolixin),
- Thorazine (Chlorpromazine),
- Ziprasidone (Geodon)
-
-
- Compazine (Prochlorperazine),
- Promethazine (Phenergan),
- Hydroxyzine (Vistaril),
- Metoclopramide (Reglan)
- If the patient is hemodynamically unstable, request an order of OLMC: Epinephrine 1:10,000 0.01 mg/kg IV/IO; max 0.3 mg