Anaphylactic Shock

Allergic Reaction




  • 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




  • 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




  • 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





  • 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