Anaphylaxis (Severe Allergy)
Treatment of life-threatening allergic reactions
⚠️ CRITICAL: Anaphylaxis requires immediate epinephrine. Check for A, B, or C symptoms!
Recognizing Anaphylaxis
Look for systemic effects - need exposure to allergen + A, B, or C symptoms:
| System | Signs/Symptoms |
|---|---|
| A | Airway: Swelling lips/tongue/throat, stridor, difficulty swallowing, voice change |
| B | Breathing: Wheeze, cough, dyspnea, reduced O2 sat |
| C | Circulation: HR increased, BP <90 mmHg, syncope/collapse |
| D | Skin: Hives, red blotchy rash, itching (Skin alone is NOT anaphylaxis) |
| GI | Nausea, vomiting, diarrhea, cramps (GI alone is NOT anaphylaxis) |
Indications for Epinephrine
- Exposure to allergen + A, B, or C symptoms
- D (skin) or GI findings do NOT have to be present
- D or GI alone = NOT anaphylaxis
Treatment - Give Epinephrine IMMEDIATELY
First Aid
- Call for help
- Remove allergen if possible
- Assist patient to use their own EpiPen
FR (First Responder)
- Call for help, remove allergen
- Give 1 EpiPen (0.3 mg) as directed by device
- EpiPen Jr (0.15 mg) for pediatrics based on weight
AFA/EMR
- Call for help, remove allergen
- Give Epinephrine 0.3-0.5 mg IM in thigh (BC: pre-drawn) OR 0.3 mg EpiPen
- May repeat in 5-15 min if no improvement
RN, LPN, RPN, PCP, ACP
- Call for help, remove allergen
- Give Epinephrine 0.3-0.5 mg IM in thigh
- May repeat in 5-15 min if no improvement
- Salbutamol (Ventolin) 4-8 puffs or 5 mg via nebulizer for wheezing
- Nurses/ACPs: Diphenhydramine (Benadryl) 50 mg IM/IV
Pediatric (children)
- Epinephrine 0.01 mg/kg IM in thigh (max 0.5 mg)
- EpiPen or EpiPen Jr based on weight
- May repeat in 5-15 min, up to 3 doses
- Salbutamol: 3-6 puffs or 2.5 mg nebulized (<25kg) OR 4-8 puffs or 5 mg (>25kg)
Quick Dosing Reference
| Patient Type | Epinephrine Dose |
|---|---|
| Adult | 0.3-0.5 mg IM (thigh) |
| Pediatric | 0.01 mg/kg IM (max 0.5 mg) |
| EpiPen | 0.3 mg (adult) |
| EpiPen Jr | 0.15 mg (pediatric) |
After Epinephrine
- Arrange transfer to hospital/field clinic
- Cardiac monitor if available
- Serial vitals every 3-5 min initially, then as needed
- Monitor AVPU or GCS throughout
- Observe for 4+ hours if transport impractical (consult CDM)
Key Safety Points
- Epinephrine IM in lateral thigh ONLY (not IV unless cardiac arrest)
- Use sharps disposal container
- History of severe reaction = higher risk
- Don't delay - give epinephrine first, ask questions later
⚠️ Remember: Anaphylaxis = Allergen exposure + A, B, or C symptoms. When in doubt, give epinephrine - it's safe and can be life-saving!
Source: Odyssey Medical Consulting
Version: 2025-01-05