Anaphylaxis

2. Diagnosis: Anaphylaxis

3. Condition:

4. Vital signs: q1h; Call physician if BP systolic >160, <90; diastolic. >90, <60; P >120, <50; R>25, <10; T >38.5°C

5. Activity: Bedrest

6. Nursing: O2 at 6 L/min by NC or mask. Keep patient in Trendelenburg's position, No. 4 or 5 endotracheal tube at bedside.

8. IV Fluids: 2 IV lines. Normal saline or LR 1 L over 1-2h, then D5 / NS at 125 cc/h. Foley to closed drainage.

9. Special Medications: Gastrointestinal Decontamination:

-Gastric lavage if indicated for recent oral ingestion. -Activated charcoal 50-100 gm, followed by cathartic.

Bronchodilators:

-Epinephrine (1:1000) 0.3-0.5 mL SQ or IM q10min or 1-4 mcg/min IV OR in severe life threatening reactions, give 0.5 mg (5.0 mL of 1: 10,000 sln) IV q5-10min prn. Epinephrine, 0.3 mg of 1:1000 sln may be injected SQ at site of allergen injection OR -Albuterol (Ventolin) 0.5%, 0.5 mL in 2.5 mL NS q30min by nebulizer prn OR -Aerosolized 2% racemic epinephrine 0.5-0.75 mL.

Corticosteroids:

-Methylprednisolone (Solu-Medrol) 250 mg IV x 1, then 125 mg IV q6h OR -Hydrocortisone sodium succinate 200 mg IV x 1, then 100 mg q6h, followed by oral prednisone 60 mg PO qd, tapered over 5 days.

Antihistamines:

-Diphenhydramine (Benadryl) 25-50 mg IV q4-6h OR -Hydroxyzine (Vistaril) 25-50 mg IM or PO q2-4h. -Cimetidine (Tagamet) 300 mg IV or PO q6h OR -Ranitidine (Zantac) 150 mg IV or PO bid.

Pressors and other Agents:

-Norepinephrine (Levophed) 8-12 mcg/min IV, titrate to systolic 100 mmHg (8

mg in 500 mL D5W) OR -Isoproterenol (Isuprel) 0.5-5 mcg/min IV OR -Dopamine (Intropin) 5-20 mcg/kg/min IV.

10. Extras: Portable CXR, ECG, allergy/immunology consult.

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