Prehospital protocol pediatric anaphylaxis: Difference between revisions
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#Assist Ventilations with <span style="color:#add8e6"> BVM</span> as needed | #Assist Ventilations with <span style="color:#add8e6"> BVM</span> as needed | ||
==Signs Symptoms of | ==Signs Symptoms of [[Anaphylaxis]]?== | ||
Is there a known allergen exposure with hypotension or respiratory distress? | Is there a known allergen exposure with hypotension or respiratory distress? | ||
| Line 10: | Line 10: | ||
*IF (weight <25) | *IF (weight <25) | ||
**Give EpiPen Junior IM (0.15mg epinephrine 1:1000 IM) | **Give EpiPen Junior IM (0.15mg epinephrine 1:1000 IM) | ||
**If auto injector is not available, give epinephrine 1:1000 (weight * 0.01) mg IM | **If auto injector is not available, give epinephrine 1:1000 (weight *0.01) mg IM | ||
*IF (weight > 25) | *IF (weight > 25) | ||
**Give EpiPen IM (0.3mg epinephrine 1:1000 IM) | **Give EpiPen IM (0.3mg epinephrine 1:1000 IM) | ||
**If autoinjector is not available, give epinephrine (1:1000) (weight * 0.01) mg IM | **If autoinjector is not available, give epinephrine (1:1000) (weight *0.01) mg IM | ||
===No=== | ===No=== | ||
| Line 22: | Line 22: | ||
#Widespread hives, itching, swelling | #Widespread hives, itching, swelling | ||
#Persistent vomiting or abdominal pain | #Persistent vomiting or abdominal pain | ||
# | #altered mental status, syncope, or decreased consciousness | ||
==IV NS TKO, Cardiac Monitor, Pulse Oximetry== | ==IV NS TKO, Cardiac Monitor, Pulse Oximetry== | ||
*Assess for signs of poor perfusion. | |||
*If hypotension, and pulmonary edema administer 10cc/kg NS IV | |||
*If hypotension and NO pulmonary edema administer 20cc/kg NS IV | |||
*Follow Non-Traumatic Shock protocol (8.03 CC) | |||
==Wheezing or Shortness of Breath?== | ==Wheezing or Shortness of Breath?== | ||
*2.5mg/3mL NS via Nebulizer may be administered | *2.5mg/3mL Albuterol NS via Nebulizer may be administered | ||
*Repeat as needed | *Repeat as needed | ||
==Hypotension or Poor Perfusion?== | ==[[Hypotension]] or Poor Perfusion?== | ||
===Yes=== | ===Yes=== | ||
#Give (weight * 20) mL/kg NS bolus and reassess. | #Give (weight *20) mL/kg NS bolus and reassess. | ||
#Repeat bolus x 3 times if continued signs of poor perfusion | #Repeat bolus x 3 times if continued signs of poor perfusion | ||
| Line 43: | Line 42: | ||
If patient has continued signs of anaphylaxis and no epinephrine was given in the last 5 minutes then | If patient has continued signs of anaphylaxis and no epinephrine was given in the last 5 minutes then | ||
*IF (weight < 25) kg | *IF (weight < 25) kg | ||
**Give EpiPen Junior IM (0.15mg epinephrine 1:1000 IM) If auto injector is not available, give epinephrine 1:1000 (weight * 0.01) mg IM | **Give EpiPen Junior IM (0.15mg epinephrine 1:1000 IM) If auto injector is not available, give epinephrine 1:1000 (weight *0.01) mg IM | ||
*IF (weight > 25) kg | *IF (weight > 25) kg | ||
**Give EpiPen IM (0.3mg epinephrine 1:1000 IM) If autoinjector is not available, give epinephrine (1:1000) (weight * 0.01) mg/kg IM | **Give EpiPen IM (0.3mg epinephrine 1:1000 IM) If autoinjector is not available, give epinephrine (1:1000) (weight *0.01) mg/kg IM | ||
==Give Diphenhydramine | ==Give Diphenhydramine 1mg/kg IV/IM== | ||
*Max dose 50mg | |||
==Notify Receiving Hospital== | ==Notify Receiving Hospital== | ||
#Continue transport, and frequent reassessments | #Continue transport, and frequent reassessments | ||
#Contact online medical control if in need of further instructions | #Contact online medical control if in need of further instructions | ||
==See Also== | |||
*[[Anaphylaxis]] | |||
[[Category:EMS]] | [[Category:EMS]] | ||
Latest revision as of 08:38, 7 January 2020
Perform general assessment
- 100% O2 NRB
- Check Vital Signs
- Assist Ventilations with BVM as needed
Signs Symptoms of Anaphylaxis?
Is there a known allergen exposure with hypotension or respiratory distress?
Yes
- IF (weight <25)
- Give EpiPen Junior IM (0.15mg epinephrine 1:1000 IM)
- If auto injector is not available, give epinephrine 1:1000 (weight *0.01) mg IM
- IF (weight > 25)
- Give EpiPen IM (0.3mg epinephrine 1:1000 IM)
- If autoinjector is not available, give epinephrine (1:1000) (weight *0.01) mg IM
No
Acute onset of symptoms and 2 or more of the following?
- Hypotension, cyanosis, delayed cap refill
- Dyspnea, wheezing, stridor, or respiratory distress
- Throat tightness or facial/lip/tongue swelling
- Widespread hives, itching, swelling
- Persistent vomiting or abdominal pain
- altered mental status, syncope, or decreased consciousness
IV NS TKO, Cardiac Monitor, Pulse Oximetry
- Assess for signs of poor perfusion.
- If hypotension, and pulmonary edema administer 10cc/kg NS IV
- If hypotension and NO pulmonary edema administer 20cc/kg NS IV
- Follow Non-Traumatic Shock protocol (8.03 CC)
Wheezing or Shortness of Breath?
- 2.5mg/3mL Albuterol NS via Nebulizer may be administered
- Repeat as needed
Hypotension or Poor Perfusion?
Yes
- Give (weight *20) mL/kg NS bolus and reassess.
- Repeat bolus x 3 times if continued signs of poor perfusion
Recurrent signs of Anaphylaxis?
If patient has continued signs of anaphylaxis and no epinephrine was given in the last 5 minutes then
- IF (weight < 25) kg
- Give EpiPen Junior IM (0.15mg epinephrine 1:1000 IM) If auto injector is not available, give epinephrine 1:1000 (weight *0.01) mg IM
- IF (weight > 25) kg
- Give EpiPen IM (0.3mg epinephrine 1:1000 IM) If autoinjector is not available, give epinephrine (1:1000) (weight *0.01) mg/kg IM
Give Diphenhydramine 1mg/kg IV/IM
- Max dose 50mg
Notify Receiving Hospital
- Continue transport, and frequent reassessments
- Contact online medical control if in need of further instructions