Prehospital protocol pediatric anaphylaxis

Perfom general assesment

  1. 100% O2 NRB
  2. Check Vital Signs
  3. Assist Ventilations with BVM as needed

Signs Symptoms of Anapylaxis?

Is there a known allergen exposure with hypotension or respiratory distress?

Yes

  • IF (weight) <25kg
    • 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) > 25kg
    • Give EpiPen IM (0.3mg epinephrine 1:1000 IM) If autoinjector is not available, give epinephrine (1:1000) (weight * 0.01) mg/kg IM

No

Acute onset of symptoms and 2 or more of the following?

  1. Hypotension, cyanosis, delayed cap refill
  2. Dyspnea, wheezing, stridor, or respiratory distress
  3. Throat tightness or facial/lip/tongue swelling
  4. Widespread hives, itching, swelling
  5. Persistent vomitting or abdominal pain
  6. AMS, syncope, or decreased consciousness

Yes

  • IF (weight) <25kg
    • Give EpiPen Junior IM (0.15mg epinephrine 1:1000 IM) If auto injector is not available, give epinephrine 1:1000 (weight * 0.01) mg/kg IM
  • IF (weight) > 25kg
    • Give EpiPen IM (0.3mg epinephrine 1:1000 IM) If autoinjector is not available, give epinephrine (1:1000) (weight * 0.01) mg/kg IM

IV NS TKO, Cardiac Monitor, Pulse Oximetry

Give Diphenhydramine (weight * 1.0) mg IV/IM

Wheezing or Shortness of Breath?

2.5mg/3mL NS via Nebulizer may be administered

Recurent signs of Anaphylaxis?

If patient has continued signs of anaphylaxis and no epinephrine was given in the last 5 minutes then

  • IF (weight) <25kg
    • 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) > 25kg
    • Give EpiPen IM (0.3mg epinephrine 1:1000 IM) If autoinjector is not available, give epinephrine (1:1000) (weight * 0.01) mg/kg IM

Hypotension or Poor Perfusion?

Yes

  1. Give (weight * 20) mL/kg NS bolus and reassess.
  2. Repeat bolus x 3 times if continued signs of poor perfusion

Notify Recieving Hospital

  1. Continue transport, and frequent reassessments
  2. Contact online medical control if in need of further instructions
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