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

• Benadryl 50 mg IM or 25 mg 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.

 

• • Methylprednisolone (Solu-Medrol) 125 mg IV

 

Respiratory distress ?

 

• Yes

 

• • Albuterol (Ventolin) 5 mg via nebulizer

 

• No

 

• • Notify receiving facility or contact Medical Control

 

 

PEARLS:

 

• If the patient is hemodynamically unstable, request an order of Epinephrine 1:10,000 0.5 - 1mL/0.05 - 0.1 mg

• 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.