2.02P - Allergic Reaction / Anaphylaxis

First-Responder (Standing Orders)

1.0 Routine Patient Care
In anaphylaxis, if patient is over 6 months age and under 25kg, administer epinephrine 0.15mg via auto-injector or IM.
If body weight is over 25 kg, administer epinephrine 0.3mg via auto-injector or IM.
When administering IM, EMTs may do so in accordance withProtocol 6.6 Check and Inject Epinephrinefor BLS Providers.

First-Responder (Medical Control)

Contact Medical Control if second dose of epinephrine is required after 5 minutes.
First Responder and EMTs must contact Medical Control prior to administration of epinephrine when patient is under 6 months of age

EMT-Basic (Standing Orders)

Follow above protocols

EMT-Advanced (Standing Orders)

In anaphylaxis, if patient is over 6 months age and under 25kg, administer epinephrine 0.15mg via auto-injector or IM.
If body weight is over 25 kg, administer epinephrine 0.3mg via auto-injector or IM.
Must be administered in accordance with criteria listed inA1 Adult Medication Reference.
Contact Medical Control if second epinephrine dose required after 5 minutes

EMT-Paramedic (Standing Orders)

Albuterol (via nebulizer):

If age less than 2 years, 1.25 mg by nebulizer
If age 2 years or greater, 2.5-3 mg by nebulizer

Give hydrocortisone 2 mg/kg to max. 100 mg IV/IO/IM, or methylprednisolone 2 mg/kg to max. 125 mg IV/IO/IM
Diphenhydramine 1 mg/kg up to max. single dose of 50 mg IV/IO/IM
Contact Medical Control if second epinephrine dose required after 5 minutes.

EMT-Paramedic (Medical Control)

Additional doses of above medications.
Epinephrine infusion 1:1,000 (1 mg/mL) 0.1-1 mcg/kg/min IV/IO
Epinephrine 1:10,000; 0.01mg/kg IV/IO to max. single dose 0.3 mg.

Caution:

Epinephrine for anaphylaxis must be administered by Auto-Injector or IM if trained and authorized to do so in accordance withMedical Director Option Protocol 6.6 Check and Inject Epinephrine for BLS Providers.
For patients under 12 years old, the airway is in most cases best managed with a BVM or SGA. In some cases, intubation may be preferred. This is at the discretion of the treating paramedic.

Note:

Clinical Criteria for Anaphylaxis:
If one of these criteria is fulfilled, treat for anaphylaxis

Acute onset of skin or mucosal involvement with at least one of the following:

a. Respiratory compromise
b. Decreased SBP or evidence of end-organ hypoperfusion

Two or more of these occurring rapidly after exposure to a likely antigen:

a. Skin or mucosal involvement
b. Respiratory compromise
c. Decreased SBP or evidence of end-organ hypoperfusion
d. Persistent GI symptoms

Decreased BP after exposure to a known allergen for that patient

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