Allergic Reaction: Anaphylaxis

Allergic Reaction: 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, cool, pale, cyanosis, diaphoresis

EMT—basic/intermediate

Remove source of allergy; immediately remove stinger(s); scraping preferred (tweezers may inject more venom), but do not delay removal if only tweezers available
Establish ABCs, and insert nasal or oral airway if indicated
Administer high-flow O₂, or manually ventilate as indicated
Elevate legs, and keep Pt warm if exhibiting signs of shock
Administer medications as permitted by protocol (see below)

Paramedic

Management by Severity of Signs and Symptoms^*

Mild: itching, rash or hives only	Diphenhydramine: 25–50 mg IV, IM Cimetidine: 300 mg IV, IM, PO
Moderate: above s/s + 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 + dyspnea	Epinephrine (1:1,000): 0.3–0.5 mg SC (may be administered by EMT-I or EMT-P)
Critical: above s/s + airway closure, hypotension (anaphylaxis)	IV fluids: goal SBP >90 mm Hg Epinephrine (1:10,000): 0.1 mg (1 mL) IV Dopamine: start at 10 mcg/kg/min Glucagon: 1 mg IV, IM (if unresponsive to epinephrine or Pt taking beta blockers)

^*Give all drugs up to and including the Pt level of severity