ANAPHYLACTIC SHOCK
1.Eliminate any allergy triggers
2.Get ready for intubation as edema can progress shortly.
3.Provide oxygen flow.
4.Provide reliable intravenous access with large bore cannula.
5.Give 20-30 mL/kg crystalloid iv.
6.Epinephrine. Try the available routs:
- Nebulized 5 mg standard epinephrine (5 mLs of 1 mg/mL) if patient has stridor.
- IM bolus 0.3-0.5 mg (use 1 mg/mL concentration)
- IV bolus 5-20 mcg (use 10 mcg/mL concentration)
- IV infusion 1-20 mcg/min
7.Alternative agents:
- epinephrine 100 mcg IV bolus
- norepinephrine infusion 0.1 mcg/kg/min
- vasopressin 0.01-0.04 units/min or 2 U bolus (0.03 U/kg)
- glucagon 1 mg IV over 5 min (for beta blocker reversal) start infusion 5-15 mcg/min if needed (common side effect of nausea/vomiting)
- methylene blue 1.5-2 mg/kg IV bolus add continuous infusion of 0.5 mg/kg/hr in refractory cases
8.Adjunctive therapy when hemodynamically stable
- PO prednisone 1 mg/kg (maximum of 50 mg) or
IV dexamethasone 0.2-0.4 mg/kg (maximum 10 mg) or
IV methylprednisolone 125 mg
- diphenhydramine 1-2 mg/kg (up to 50 mg)
- H2 blocker: cimetidine 300 mg or ranitidine 50 mg PO or IV