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;

 

• • Albuterol (Ventolin) 5 mg Adult, 2.5 mg PED via nebulizer

 

• • 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.