Adult Anaphylaxis

Question 1

Adult Anaphylaxis - Anaphylaxis criteria?

Answer 1

Suspected exposure with mucosal/skin signs and at least 1 of the following:
Respiratory S/S
BP < 90
Or 
Suspected allergen and 2  of the following:
Skin or mucosal signs and symptoms
Gastrointestinal symptoms
Respiratory S/S
BP < 90

Question 2

Adult Anaphylaxis - Initial treatment for pt who meet anaphylaxis criteria?

Answer 2

Epi 0.3 mg q 5 to max of 0.9 mg
Benadryl 1 mg/kg to max of 50 mg
Prednisone 50 mg PO or dexamethasone 8 mg IV

Question 3

Adult Anaphylaxis - Anaphylaxis and bronchospasm Tx?

Answer 3

Concurrent treatment with bronchospasm protocol

Question 4

Adult Anaphylaxis - Refractory or ongoing symptoms?

Answer 4

Epi (0.1 mg/ml) 0.1 mg SIVP q 2 min total max of 1 mg
BP < 90 mmHg - 500 ml boluses to 2 L
Mandatory OLMC
Epi infusion 1 mcg/min to max of 8 mcg/min
Glucagon 1 mg IV q 5 max of 5 mg

Question 5

Adult Anaphylaxis - epiNEPHrine (1mg/mL) indication?

Answer 5

Anaphylaxis

Question 6

Adult Anaphylaxis - epiNEPHrine (1mg/mL) dose?

Answer 6

0.3 mg IM q 5 min to a total max of 0.9 mg

Question 7

Adult Anaphylaxis - epiNEPHrine (1mg/mL) contraindications?

Answer 7

None when used in emergency situations
Hypersensitivity
Underlying cardiovascular disease

Question 8

Adult Anaphylaxis - epiNEPHrine (1mg/mL) precautions?

Answer 8

IM in lateral quad

All patients receiving epiNEPHrine must be cardiac-monitored

Question 9

Adult Anaphylaxis - diphenhydrAMINE indications?

Answer 9

Anaphylaxis

Question 10

Adult Anaphylaxis - diphenhydrAMINE dose?

Answer 10

1 mg/kg PO/IM/SIVP/IO to a single max of 50 mg

Question 11

Adult Anaphylaxis - diphenhydrAMINE contraindications?

Answer 11

Hypersensitivity to diphenhydrAMINE or dimenhyDRINATE

Question 12

Adult Anaphylaxis - diphenhydrAMINE precautions?

Answer 12

IM injections in quad

avoid antihistamines in nursing mothers and neonates

Question 13

Adult Anaphylaxis - predniSONE indications?

Answer 13

Anaphylaxis

Question 14

Adult Anaphylaxis - predniSONE dose?

Answer 14

50 mg PO

Question 15

Adult Anaphylaxis - predniSONE contraindications?

Answer 15

Difficulty swallowing

Patients already taking predniSONE

Question 16

Adult Anaphylaxis - predniSONE onset?

Answer 16

2 – 4 hours

Question 17

Adult Anaphylaxis - dexamethasone indications?

Answer 17

Anaphylaxis

Question 18

Adult Anaphylaxis - dexamethasone dose?

Answer 18

8 mg PO/IM/SIVP/IO

Question 19

Adult Anaphylaxis - dexamethasone contraindications?

Answer 19

Systemic fungal infections
Hypersensitivity to dexamethasone or other steroids
Hypersensitivity to benzyl alcohol or sodium sulfite

Question 20

Adult Anaphylaxis - dexamethasone onset?

Answer 20

2 – 4 hours

Question 21

Adult Anaphylaxis - epiNEPHrine Infusion indications?

Answer 21

Anaphylaxis refractory to 500 mL bolus and transport time > 30 minutes

Question 22

Adult Anaphylaxis - epiNEPHrine Infusion dose?

Answer 22

IV/IO start at 1 mcg/min to a max of 8 mcg/min

Question 23

Adult Anaphylaxis - epiNEPHrine Infusion contraindications?

Answer 23

None when used in emergency situations

Question 24

Adult Anaphylaxis - epiNEPHrine Infusion precautions?

Answer 24

Mandatory pre-notification to receiving facility

Question 25

Adult Anaphylaxis - epiNEPHrine Infusion administration?

Answer 25

1.5 mg epiNEPHrine (1mg/mL) to 250 mL D5W = 6 mcg/mL

Use the Drip Rate Flow Controller with a 60 drop set

Question 26

Adult Anaphylaxis - glucagon indications?

Answer 26

Refractory hypotension and patient currently on beta blocker therapy

Question 27

Adult Anaphylaxis - glucagon dose?

Answer 27

1 mg IV/IO q 5 min to a total max of 5 mg

Question 28

Adult Anaphylaxis - glucagon contraindications?

Answer 28

Hypersensitivity to glucagon, beef or pork proteins