Anaphylaxis is an acute, potentially fatal, multi‑organ system reaction caused by the release of chemical mediators from mast cells and basophils. [1, 2] The classic form involves prior sensitization to an allergen with later re‑exposure, producing symptoms via an immunologic mechanism.
Essentials
Intramuscular (IM) epiNEPHrine administration is indicated for initial care of a patient with systemic signs of anaphylaxis. The anterolateral mid‑thigh is the preferred site due to improved absorption.
Intravenous (IV) epiNEPHrine administration should be reserved for the patient who is extremely poorly perfused or facing impending cardiac arrest. IV epiNEPHrine should only be considered after IM epiNEPHrine.
EpiNEPHrine auto injectors are an appropriate treatment for anaphylaxis and EMRs can administer a patient’s epiNEPHrine auto injector when associated with signs & symptoms of anaphylaxis.
DO NOT DELAY TREATMENT
Additional Treatment Information
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Referral Information
Needs to go to Victoria General Hospital
General Information
Anaphylaxis is an acute, potentially fatal, multi‑organ system reaction caused by the release of chemical mediators from mast cells and basophils. [1, 2] The classic form involves prior sensitization to an allergen with later re‑exposure, producing symptoms via an immunologic mechanism.
Interventions
First Responder (FR) Interventions
Position patient supine to improve blood pressure
Do not walk the patient
Remove allergen
Supplemental oxygen
Administer patient’s prescribed epiNEPHrine autoinjector
Emergency Medical Responder (EMR) & All License Levels Interventions
Position patient supine to improve blood pressure
Do not walk the patient
Remove allergen
Supplemental oxygen
Administer patient’s prescribed epiNEPHrine autoinjector
Primary Care Paramedic (PCP) Interventions
EpiNEPHrine (IV/IO) if refractory to other routes of epinephrine.
1.0mcg epiNEPHrine IV to a BP of 90 systolic (max dose 0.8mcg/min)
Glucagon for persistent hypotension despite fluids & epinephrine in patients on ACE inhibitors or beta blockers.
CliniCall Referral
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Advanced Care Paramedic (ACP) Interventions
EpiNEPHrine (IV/IO) if refractory to other routes of epinephrine. 1.0mcg epiNEPHrine IV to a BP of 90 systolic (max dose 0.8mcg/min) Glucagon for persistent hypotension despite fluids & epinephrine in patients on ACE inhibitors or beta blockers. CliniCall ReferralDiphenhyDRAMINE to mitigate medium term effects and
Community Paramedic (CP) Interventions
EpiNEPHrine (IV/IO) if refractory to other routes of epinephrine. 1.0mcg epiNEPHrine IV to a BP of 90 systolic (max dose 0.8mcg/min) Glucagon for persistent hypotension despite fluids & epinephrine in patients on ACE inhibitors or beta blockers. CliniCall ReferralDiphenhyDRAMINE to mitigate medium term effects and
Critical Care Paramedic (CCP) Interventions
EpiNEPHrine (IV/IO) if refractory to other routes of epinephrine. 1.0mcg epiNEPHrine IV to a BP of 90 systolic (max dose 0.8mcg/min) Glucagon for persistent hypotension despite fluids & epinephrine in patients on ACE inhibitors or beta blockers. CliniCall ReferralDiphenhyDRAMINE to mitigate medium term effects and
Algorithm
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Evidence Based Practice
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References
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