- MEDICAL EMERGENCIES
3.2 ALLERGIC REACTION / ANAPHYLAXIS
Anaphylaxis is an acute, generalized, and violent antigen-antibody reaction that can be rapidly fatal. An Anaphylactic Reaction may present as a mild to severe response; management is based upon severity. There are multiple causes of anaphylaxis: most commonly these causes are injected substances or drugs such as: penicillin, cephalosporins, sulfonamides, iron, and thiamine. Other causes include food sensitivities, vaccines, contrast dyes, insect sting(s) and other environmental allergens. Most reactions occur within thirty minutes following allergen exposure, although the onset of symptoms can vary from several seconds to hours.
ASSESSMENT / TREATMENT PRIORITIES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway and assist ventilations as needed.
3. Administer high concentration oxygen by non-rebreather mask.
4. Determine patient's hemodynamic stability and symptoms. Continually assess Level of consciousness, ABCs and Vital Signs.
5. Obtain appropriate history related to event, Past Medical History including anaphylaxis, Medications, Drug Allergies and Substance Abuse.
6. Determine if patient is in mild or severe distress:
a. Mild Distress: itching, isolated urticaria, nausea, no respiratory distress.
b. Severe Distress: stridor, bronchospasm, severe abdominal pain, respiratory distress, tachycardia, shock (systolic BLOOD PRESSURE <90), observe for edema of lips, tongue or face and generalized urticaria.
TREATMENT
BASIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway. This may include repositioning of the airway, suctioning, or use of airway adjuncts (oropharyngeal airway/ nasopharyngeal airway) as indicated. Assist ventilations as needed.
3. Administer high concentration of oxygen by non-rebreather mask.
4. Activate ALS intercept, if deemed necessary and if available.
5. *SPECIAL CONSIDERATION: Use of Auto-Injector Epi-pen. NOTE: Patients under age 5 or over age 65 require contact with Medical Control prior to administration of epinephrine.
a. If patient presents in Severe Distress, as defined in Assessment Priorities, prior to or after contact with Medical Control: administer epinephrine by auto-injection. A second injection in 5 minutes may be necessary.
b. Monitor vital signs every 5 minutes.
6. Initiate transport as soon as possible with or without ALS.
7. Notify receiving hospital.
* ONLY EMTs with Auto-Injector Epi-Pen training and Regional credentials may administer Epi-Pen emergency treatment.
INTERMEDIATE PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway. This may include repositioning of the airway, suctioning, or use of airway adjuncts (oropharyngeal airway/ nasopharyngeal airway) as indicated. Assist ventilations as needed.
3. Administer high concentration of oxygen by non-rebreather mask.
4. Activate Paramedic intercept, if deemed necessary and if available.
5. *SPECIAL CONSIDERATION: Use of Auto-Injector Epi-pen. NOTE: Patients under age 5 or over age 65 require contact with Medical Control prior to administration of epinephrine.
a. If patient presents in Severe Distress, as defined in Assessment Priorities, prior to or after contacting Medical Control: administer epinephrine by auto-injection. A second injection in 5 minutes may be necessary.
b. Monitor vital signs every 5 minutes.
6. ALS STANDING ORDERS
a. Provide advanced airway management, if indicated.
b. Initiate IV Normal Saline titrated to BLOOD PRESSURE >90 while en route.
7. Initiate transport as soon as possible with or without Paramedics.
8. Contact MEDICAL CONTROL. The following may be ordered:
a. Application of PASG/MAST if hypotension persists. CAUTION: PASG/MAST will increase peripheral vascular resistance and can worsen pulmonary edema commonly seen in these patients.
9. Notify receiving hospital.
* ONLY EMTs with Auto-Injector Epi-Pen training and Regional credentials may administer Epi-Pen emergency treatment.
PARAMEDIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Maintain an open airway. This may include repositioning of the airway, suctioning, or use of airway adjuncts (oropharyngeal airway / nasopharyngeal airway) as indicated. Assist ventilations as needed.
3. Administer high concentration of oxygen by non-rebreather mask.
4. STANDING ORDERS
a. Provide advanced airway management (if indicated).
b. Initiate IV Normal Saline titrated to BLOOD PRESSURE >90 while en route.
c. Mild Distress: monitor for signs of severe distress.
d. Severe Distress:
- Epinephrine (1:1,000) 0.3 mg - 0.5 mg SC; a second dose may be required.
- Large Bore IV normal saline, titrate to BLOOD PRESSURE >90.
- Benadryl 25 mg- 50 mg IV push or deep IM.
- Albuterol 0.5% (0.5 ml mixed with 3 ml of Normal Saline) via nebulizer.
5. Initiate Transport as soon as possible.
6. Contact MEDICAL CONTROL. The following may be ordered:
a. Epinephrine (1:1,000) 0.3 mg - 0.5 mg SC.
b. Epinephrine (1:10,000) 0.1 mg - 0.5 mg IV Push.
c. Epinephrine Infusion 1-10 mg/minute. Mix Epinephrine (1:1000) 1 mg in 250 ml Normal Saline. (30 microdrops/minute = 2 mg / min.)
d. Albuterol 0.5% (0.5 ml mixed with 3 ml of Normal Saline) via nebulizer.
e. Benadryl 25 mg- 50 mg IV Push or deep IM.
f. Dopamine infusion 2 - 20 mg/Kg minute (Rate determined by physician)
g. Application of PASG/MAST if hypotension persists. CAUTION: PASG/MAST will increase peripheral vascular resistance but can worsen pulmonary edema commonly seen in these patients.
7. Notify receiving hospital.
* ONLY EMTs with Auto-Injector Epi-Pen training and Regional credentials may administer Epi-Pen emergency treatment.
MoonDragon's EMS Index Page
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-- by Phyllis A. Balch, James F. Balch - 2nd Edition
-- by Phyllis A. Balch, James F. Balch - 4th Edition
-- by Phyllis A. Balch
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