Allergic Reaction

 

History:

 

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

 

Significant Findings:

 

  • Itching/hives
  • Respiratory distress
  • Chest/throat constriction
  • Difficulty swallowing
  • Hypotension/shock
  • Nausea
  • Vomiting

 

Differential:

 

  • Urticaria (rash only)
  • Anaphylaxis (systemic effect)
  • Shock (vascular effect)
  • Angioedema (drug induced)
  • Aspiration/airway obstruction
  • Vasovagal event
  • Asthma
  • COPD
  • CHF

 

DO NOT use this order if chest pain is thought to be cardiac in origin

 

Treatment:

 

 

 

  • Oxygen

 

 

 

  • 12-Lead EKG

 

 

 

 

  • Initiate IV

 

 

 

 

 

 

Hives/rash only; No respiratory component or dystonic reaction ?

 

  • No

 

    • Notify receiving facility or contact Medical Control if needed.

 

Immediately begin rapid treatment

if any of the following S/S are present.

 

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

 

  • Yes

 

 

 

    • Epinephrine 1: 1,000 0.5 mg IM, may be repeated every 15 mins; max 4 doses.

 

 

 

    • Normal Saline up to a 1,000 mL to reverse the signs of hypotension.

 

 

 

 

Respiratory distress ?

 

  • Yes

 

 

 

 

  • No

 

    • Notify receiving facility or contact Medical Control

 

 

PEARLS:

 

  • Ace inhibitors can cause isolated angioedema (i.e., lip swelling without airway involvement).
  • Common Ace inhibitors include Zestril (Lisinopril), Tritace (Ramipril), Renitec (Enalapril), Vasostad (Captopril), Cibacen (Benazepril).
  • Methylprednisolone (Solumedrol) 125 mg IV can be administered to isolated angioedema caused by Ace Inhibitors.

 

 

 

 

  • An Adult Epi-pen auto-injector can be used in lieu of Epinephrine 1:1,000  0.3mL  IM, may be repeated once in 5 minutes by a basic EMT

 

 

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

NREMT

National Registry Emergency Medical Technician