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

NRAEMT

NRP

National Registry Paramedic

NRAEMT

National Registry Advance Emergency Technician

NRAEMT

NRP

National Registry Paramedic

NRAEMT

National Registry Advance Emergency Technician

NREMT

National Registry Emergency Medical Technician