Exclude Patient Type Detail Header
No
Footnote
<sup>16</sup> Monitor pts, preferably w/ continuous hemodynamic monitoring including: BP, continuous pulse rate, pulse ox, ECG. Obtain IV accessASAP.
<br><br>
<sup>17</sup> There is a broad spectrum of anaphylaxis presentations that require clinical judgment. Do not rely on signs of shock for dx [S/C].
<br><br>
<sup>18</sup> GI sx include persistent vomiting, abdominal cramps, diarrhea.
<br><br>
<sup>19</sup> The q5min frequency can be liberalized to permit more frequent injections per clinician judgment.
<br><br>
<sup>20</sup> If IV access not readily available, obtain IO access and administer epi or fluid resuscitation via this route [M/D].
<br><br>
<sup>21</sup> Epi infusion 1:1,000,000: prepare by adding 1 mg (1 mL) 1:1000 epi to 1000mL D<sub>5</sub>W/NS; start at 0.1 mcg/kg/min for children, 1 mcg/min for adolesc/adults, max 10 mcg/min. If refractory to infusion, a slow 50 mcg IV bolus (0.5 mL of 1:10,000 epi) may be used.
<br><br>
<sup>22</sup> Diff dx includes: cardiogenic/hypovolemic/obstructive/hemorrhagic shock, ACEI-associated or hereditary angioedema, vocal cord dysfxn, tumor-related flushing, asthma, CHF, PE, drug rxn, mast cell disorder, psychiatric disorder.
<br><br>
<sup>23</sup> Risk factors for severe/potentially fatal anaphylaxis: delayed epi administration, asthma, hx of biphasic rxns, CV dz; consider these
in pt mgmt and disposition.
<br><br>
<sup>24</sup> Glucagon dose: 1-5 mg (20-30 mcg/kg [max 1 mg] in children) IV over 5 min, followed by infusion of 5-15 mcg/min titrated to response.
<br><br>
<sup>25</sup> Several case reports of successful resuscitation of refractory
anaphylaxis involving ECMO or operative cardiopulmonary bypass.
<br><br>
<sup>26</sup> Examples of corticosteroid doses: methylprednisolone 1-2 mg/kg/dose or equivalent; oral doses of prednisone also can be considered (1 mg/kg, up to 50 mg).
<br><br>
<sup>27</sup> Serum tryptase rise (drawn at 15 min and 60 min) of ≥2 mcg/L has 73% sensitivity and 98% specificity for anaphylaxis. Typically peaks 1-2 h after onset if nonfood-related.
<br><br>
<sup>28</sup> Consider longer periods of observation in pts who ingested the allergen, required >1 dose of epi, had hypotension or pharyngeal edema, or hx of asthma.
<br><br>
<sup>29</sup> Cause of anaphylaxis frequently unknown at time of D/C, making allergist F/U extremely important.
<br><br>
<sup>30</sup> No studies have evaluated the benefits of these medications after pts leave the ED if their sx of anaphylaxis have resolved prior to D/C.
<br><br>
<br><br>
<sup>17</sup> There is a broad spectrum of anaphylaxis presentations that require clinical judgment. Do not rely on signs of shock for dx [S/C].
<br><br>
<sup>18</sup> GI sx include persistent vomiting, abdominal cramps, diarrhea.
<br><br>
<sup>19</sup> The q5min frequency can be liberalized to permit more frequent injections per clinician judgment.
<br><br>
<sup>20</sup> If IV access not readily available, obtain IO access and administer epi or fluid resuscitation via this route [M/D].
<br><br>
<sup>21</sup> Epi infusion 1:1,000,000: prepare by adding 1 mg (1 mL) 1:1000 epi to 1000mL D<sub>5</sub>W/NS; start at 0.1 mcg/kg/min for children, 1 mcg/min for adolesc/adults, max 10 mcg/min. If refractory to infusion, a slow 50 mcg IV bolus (0.5 mL of 1:10,000 epi) may be used.
<br><br>
<sup>22</sup> Diff dx includes: cardiogenic/hypovolemic/obstructive/hemorrhagic shock, ACEI-associated or hereditary angioedema, vocal cord dysfxn, tumor-related flushing, asthma, CHF, PE, drug rxn, mast cell disorder, psychiatric disorder.
<br><br>
<sup>23</sup> Risk factors for severe/potentially fatal anaphylaxis: delayed epi administration, asthma, hx of biphasic rxns, CV dz; consider these
in pt mgmt and disposition.
<br><br>
<sup>24</sup> Glucagon dose: 1-5 mg (20-30 mcg/kg [max 1 mg] in children) IV over 5 min, followed by infusion of 5-15 mcg/min titrated to response.
<br><br>
<sup>25</sup> Several case reports of successful resuscitation of refractory
anaphylaxis involving ECMO or operative cardiopulmonary bypass.
<br><br>
<sup>26</sup> Examples of corticosteroid doses: methylprednisolone 1-2 mg/kg/dose or equivalent; oral doses of prednisone also can be considered (1 mg/kg, up to 50 mg).
<br><br>
<sup>27</sup> Serum tryptase rise (drawn at 15 min and 60 min) of ≥2 mcg/L has 73% sensitivity and 98% specificity for anaphylaxis. Typically peaks 1-2 h after onset if nonfood-related.
<br><br>
<sup>28</sup> Consider longer periods of observation in pts who ingested the allergen, required >1 dose of epi, had hypotension or pharyngeal edema, or hx of asthma.
<br><br>
<sup>29</sup> Cause of anaphylaxis frequently unknown at time of D/C, making allergist F/U extremely important.
<br><br>
<sup>30</sup> No studies have evaluated the benefits of these medications after pts leave the ED if their sx of anaphylaxis have resolved prior to D/C.
<br><br>
Detail Type
Image
Detail Image