Anaphylaxis/Acute Allergic Reaction
Pre-Radio
MFR/EMT/SPECIALIST/PARAMEDIC
1. Follow General Pre-Hospital Care Protocol.
2. If insect sting, remove stinger by scraping and apply cold
pack to area.
3. Elevate patient’s legs.
4. Assist patient with administration of patient’s own
Epinephrine Auto Injector (MCA approved MFR’s only), in
the patient’s anterior thigh, if EMS stock is not available.
5. Refer to Epinephrine Auto Injectors protocol.
SPECIALIST/PARAMEDIC
6. Start IV NS KVO.
7. Hypotensive patients should receive a fluid bolus, as
indicated by hemodynamic state, in 250 ml increments
and reassess. Continue fluid bolus to a maximum of 2
liters.
PARAMEDIC
8. Administer Diphenhydramine (Benadryl) 50 mg IM or IV
depending upon severity of symptoms.
9. If signs of respiratory distress, Albuterol (Proventil,
Ventolin) 2.5 mg in 3 ml of NS by nebulizer.
10. Patients with severe respiratory or hemodynamic
compromise should receive Epinephrine 0.01 ml/kg of
1:1,000 to a max of 0.5 mg (0.5 ml) IM. This may be
performed prior to starting IV.
Post-Radio
PARAMEDIC
11. Administer Epinephrine 0.1 ml/kg of 1:10,000 to a
maximum of 0.5 mg (5 ml) slow IV (over 5-10 min.) if
severe respiratory distress or hypotension.
12. Repeat, Albuterol (Proventil, Ventolin) 2.5 mg in 3 ml of
NS by nebulizer as often as indicated.
13. If no response, administer Dopamine Drip (Inotropin)
400 mg in 250 ml of NS starting at 5 mcg/kg/min with
max dosage of 20 mcg/kg/min and titrate to systolic BP
above 90 mmHg.
Pediatric Anaphylactic Reaction
This protocol serves as a guide for the care of the pediatric
patient experiencing an allergic or anaphylactic reaction.
Pre-Radio
MFR/EMT/SPECIALIST/PARAMEDIC
1. Follow General Pre-Hospital Care Protocol.
2. If insect sting, remove stinger by scraping and apply cold
pack to area.
3. Elevate patient’s legs.
4. Assist patient with administration of patient’s own
Epinephrine Auto Injector (MCA approved MFR’s only), in
the patient’s anterior thigh, if EMS stock is not available.
5. Refer to Epinephrine Auto Injectors protocol.
SPECIALIST/PARAMEDIC
6. Start IV NS KVO.
7. If hypotensive, administer 20 ml/kg NS bolus.
PARAMEDIC
8. Administer Diphenhydramine (Benadryl) 1 mg/kg IV/IM
(maximum dose 50 mg), if indicated.
9. If signs of respiratory distress, Albuterol (Proventil,
Ventolin) 2.5 mg in 3 ml of NS by nebulizer.
10. Patients with severe respiratory or hemodynamic
compromise should receive Epinephrine 1:1,000, 0.01
ml/kg IM of to a max of 0.5 mg (0.5 ml). This may be
performed prior to starting IV.
Post-Radio
PARAMEDIC
11. Repeat Epinephrine 1:1000, 0.01 ml/kg IM to a maximum
dose 0.5 mg (0.5 ml).
12. Repeat Albuterol (Proventil, Ventolin) 2.5 mg in 3 ml of
NS by nebulizer as often as indicated.
13. Administer Epinephrine 1:10,000, 0.1 ml/kg IV to a
maximum dose 0.5 mg (5.0 ml), as indicated.