ED - Acute Allergic Reaction and Anaphylaxis (> 6 months)
Last Updated: 12/5/2015 9:35:18 AM
Order Set
  Associated Pathway(s)
 Acute Allergic Reaction and Anaphylaxis (> 6 months) - http://www.curbsideup.com/link/23
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  Inclusion Criteria
Inclusion Criteria ( Any one criteria present )
  • Clinical concern for allergic or anaphylatic reaction
Exclusion Criteria
  • History of severe airway abnormality, surgery or tracheostomy
  • Pregnancy
  General
  Monitoring
Vitals per protocol
Weight
Once
  Does this patient need to be NPO?
Yes
Diet NPO
Continuous
No
PO Challenge
Diet Regular
Nursing communication
Make patient NPO for respiratory distress, mental status changes or expectation of pending surgical or other procedure requiring sedation
  Respiratory Therapy
  Supplemental Oxygen
Nursing communication
Begin supplemental oxygen therapy for persistent oxygen saturation below 90% awake, 88% asleep or severe respiratory distress.
Pulse Oximetry/O2 Sats
STAT, CONTINUOUS, Indication: When patient is on supplemental oxygen
  IV FLUIDS
  IV Fluids
Saline Lock and Flush
NS IV bolus
20 ml/kg, Intravenous, Once
D5-NS IV infusion
Intravenous, CONTINUOUS
D5-NS + KCL 20 mEq/L IV infusion
Intravenous, CONTINUOUS
D5-1/2 NS IV infusion
Intravenous, CONTINUOUS
D5-1/2 NS + KCL 20 mEq/L IV infusion
Intravenous, CONTINUOUS
  Medications
  H1 Antihistamines
Diphenhydramine (BENADRYL) 50 mg/mL injection
1 mg/kg, Intravenous/Intramuscular, ONCE, Max 50 mg
DiphenhydrAMINE (BENADRYL) capsule
50 mg, Oral, ONCE
DiphenhydrAMINE (BENADRYL) oral solution
1 mg/kg, Oral, ONCE, Max 50 mg
  Pain Control
lidocaine (ELA-MAX, LMX) 4% cream
Topical, ONCE, Apply small amount to skin PRN, painful procedure, Note: takes 30 min to reach peak effect,,
lidocaine-tetracaine (SYNERA) patch 1 Patch
Transdermal, ONCE, for 30 min, painful procedure, Note: takes 20 min to reach peak effect
  Anaphylaxis

Doses of epinephrine for anaphylaxis may be repeated after 5-15 minutes.

  Is the patient less than 10 kg?
Yes
Epinephrine 1 mg/mL injection
0.01 mg/kg, Intramuscular, ONCE, Max: 0.15 mg
  Is the patient 10 - 25 kg?
Yes
Epinephrine 1 mg/mL injection
0.15 mg, Intramuscular, ONCE
  Is the patient > 25 kg?
Yes
Epinephrine 1 mg/mL injection
0.3 mg, Intramuscular, ONCE
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