Prehospital protocol pediatric anaphylaxis

Perform general assessment

1. 100% O2 NRB
2. Check Vital Signs
3. Assist Ventilations with BVM as needed

Signs Symptoms of Anapylaxis?

Is there a known allergen exposure with hypotension or respiratory distress?

Yes

• IF (weight <25)
  • Give EpiPen Junior IM (0.15mg epinephrine 1:1000 IM)
  • If auto injector is not available, give epinephrine 1:1000 (weight *0.01) mg IM
• IF (weight > 25)
  • Give EpiPen IM (0.3mg epinephrine 1:1000 IM)
  • If autoinjector is not available, give epinephrine (1:1000) (weight *0.01) mg IM

No

Acute onset of symptoms and 2 or more of the following?

1. Hypotension, cyanosis, delayed cap refill
2. Dyspnea, wheezing, stridor, or respiratory distress
3. Throat tightness or facial/lip/tongue swelling
4. Widespread hives, itching, swelling
5. Persistent vomiting or abdominal pain
6. altered mental status, syncope, or decreased consciousness

Yes

• IF (weight <25) kg
  • Give EpiPen Junior IM (0.15mg epinephrine 1:1000 IM) If auto injector is not available, give epinephrine 1:1000 (weight *0.01) mg/kg IM
• IF (weight > 25) kg
  • Give EpiPen IM (0.3mg epinephrine 1:1000 IM) If autoinjector is not available, give epinephrine (1:1000) (weight *0.01) mg/kg IM

IV NS TKO, Cardiac Monitor, Pulse Oximetry

• Assess for signs of poor perfusion.
• If hypotension, and pulmonary edema administer 10cc/kg NS IV
• If hypotension and NO pulmonary edema administer 20cc/kg NS IV
• Follow Non-Traumatic Shock protocol (8.03 CC)

Wheezing or Shortness of Breath?

• 2.5mg/3mL Albuterol NS via Nebulizer may be administered
• Repeat as needed

Hypotensionor Poor Perfusion?

Yes

1. Give (weight *20) mL/kg NS bolus and reassess.
2. Repeat bolus x 3 times if continued signs of poor perfusion

Recurrent signs of Anaphylaxis?

If patient has continued signs of anaphylaxis and no epinephrine was given in the last 5 minutes then

• IF (weight < 25) kg
  • Give EpiPen Junior IM (0.15mg epinephrine 1:1000 IM) If auto injector is not available, give epinephrine 1:1000 (weight *0.01) mg IM
• IF (weight > 25) kg
  • Give EpiPen IM (0.3mg epinephrine 1:1000 IM) If autoinjector is not available, give epinephrine (1:1000) (weight *0.01) mg/kg IM

Give Diphenhydramine 1mg/kg IV/IM

• Max dose 50mg

Notify Receiving Hospital

1. Continue transport, and frequent reassessments
2. Contact online medical control if in need of further instructions

Authors

Daniel Ostermayer, Ross Donaldson, Neil Young