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.
*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). |