Anaphylaxis

Clinical Findings

Neuro: Anxiety, restlessness.

Resp: Dyspnea, bronchospasm, wheezing, stridor, swelling of tongue or throat, respiratory arrest.

CV: Hypotension, localized or systemic edema, CV collapse.

Skin: Rash, itching, hives, coolness, pallor, cyanosis, diaphoresis.

Collaborative Management

Remove source of allergic reaction (e.g., IV infusion, latex gloves).
If Pt is receiving blood transfusion, see Transfusion Reaction.
Monitor airway, respiratory, and circulatory status closely.
Assess for edema (specifically facial, lips, tongue, throat).
Administer or assist with STAT medication as ordered—Drugs are given up to, and including, Pt’s level of severity:

Severity	Pharmacological Intervention
MILD: Itching, rash, or hives only.	Diphenhydramine: 25–50 mg IV, IM. Cimetidine: 300 mg IV, IM, PO.
MODERATE: Above s/s plus swelling of lips or tongue.	Dexamethasone: 10 mg IV, IM or Methylprednisolone: 40–125 mg IV, IM. Albuterol: 2.5 mg nebulized in 3 mL NS.
SEVERE: Above s/s plus dyspnea.	Epinephrine(1:1000) 0.3–0.5 mg SC.
CRITICAL: Above s/s plus airway closure, hypotension (anaphylaxis).	IV fluids: Goal SBP >90 mm Hg. Epinephrine (1:10,000) 0.1–0.25 mg IV. Dopamine: Start at 10 mcg/kg/min. Glucagon: 1 mg IV over 5 min (if unresponsive to epinephrine or Pt is taking beta blockers).