Anaphylactic Shock/Allergic Reaction (BLS Only)

 

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

 

 

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

 

  • Yes

 

    • Epinephrine Auto-Injector
        • or
    • Epinephrine Anaphylaxis Kit
      • Adults: 1:1,000 0.3 mg IM
      • Pediatrics: 0.15 mg IM;

 

 

    • If conditions worsens repeat
    • Epinephrine Auto-Injector or
    • Epinephrine Anaphylaxis Kit
      • Adults: 0.3 mg;
      • Pediatrics: 0.15 mg

 

 

  • Anaphylaxis Epinephrine Kit should include the following:
    • 1 - Tuberculin syringe 1 mL
    • 2 - 20-22 gauge 1” – 1½” needles
    • 2 - Alcohol Preps
    • 1 - Epinephrine Ampule or Vial 1:1,000 – 1mg/1mL

 

 

PEARLS:

 

  • Patients 15 to 30 kg: 0.15 mg or 0.15 mL. Injection site for IM injection should be the lateral thigh.
  • Patients great than or equal to 30 kg: 0.3 mg or 0.3 mL.
  • Contact Medical Control prior to administering Epinephrine in patients who are >50 years of age, have a history of cardiac disease, or if the patients heart rate is >150.
  • The dosages follow the existing commercial Epinephrine Auto-Injector Dosages.