anaphylaxis-emergency-room

Anaphylaxis emergency room

Anaphylaxis emergency hospital treatment in an emergency room, or emergency department, or by an emergency physician:

1. Administer adrenaline (aka epinephrine) if patient suspects anaphylaxis. Prefer preservative-free adrenaline. Administer adrenaline intramuscularly (IM) (Vasctus Lateralis muscle). Concentration is 1:10000 (1mg/1ml) solution - 0.3mg. May repeat in 15 minutes if needed. Because of the risk of potentially lethal arrhythmias, adrenaline should be administered IV only in profoundly hypotensive patients or patients in cardio/respiratory arrest who have failed to respond to IV volume replacement and several injected doses of epinephrine.

2. Administer oxygen.

3. Start large bore IV access.

4. If hypotensive, then administer IV fluids.

5. If wheezing is present, then consider inhaled or nebulized bronchodilators Search instead for bronchodilators (e.g. albuterol).

6. Administer H1 and H2 blockers as supportive therapy. Prefer IV administration. Include diphenhydramine as an H1 blocker, given 25mg-50mg (or hydroxyzine/fexofenadine/), and 1mg/kg; given very slow IV diluted in normal saline over 2-5 minutes. H2 antagonist, ranitidine/cimetidine, IV, should also be given.

7. Administer corticosteroids (e.g. prednisone/) because they may prevent prolonged anaphylaxis.