1. Admit to:
2. Diagnosis: Anaphylaxis
3. Condition:
4. Vital Signs: q1-4h; call physician if BP systolic >160,<90; diastolic >90, <60;
P >120, <50; R>25, <10; T>38.5°C
5. Activity: Bedrest
6. Nursing: O2 at 6 L/min by NC or mask. Keep patient in Trendelenburg's position,
No. 4 or 5 endotracheal tube at bedside.
7. Diet: NPO
8. IV Fluids: 2 IV lines. Normal saline or LR 1 L over 1-2h, then D5 ½ NS
at 125 cc/h.Foley to closed drainage.
9. Special Medications:
Gastrointestinal Decontamination:
-Gastric lavage if indicated for recent oral ingestion.
-Activated charcoal 50-100 gm, followed by cathartic.
Bronchodilators:
-Epinephrine (1:1000) 0.3-0.5 mL SQ or IM q10min or 1-4 mcg/min IV OR in severe life
threatening reactions,give 0.5 mg (5.0 mL of 1: 10,000 sln) IV q5-10min prn. Epinephrine,
0.3 mg of 1:1000 sln maybe injected SQ at site of allergen injection OR
-Albuterol (Ventolin) 0.5%, 0.5 mL in 2.5 mL NS q30min by nebulizer prn OR
-Aerosolized 2% racemic epinephrine 0.5-0.75 mL.
Corticosteroids:
-Methylprednisolone (Solu-Medrol) 250 mg IV x 1, then 125 mg IV q6h OR
-Hydrocortisone sodium succinate 200 mg IV x 1, then 100 mg q6h, followed by oral
prednisone 60 mg PO qd, tapered over 5 days.
Antihistamines:
-Diphenhydramine (Benadryl) 25-50 mg IV q4-6h OR
-Hydroxyzine (Vistaril) 25-50 mg IM or PO q2-4h.
-Famotidine (Pepcid) 20 mg IV/PO bid.
Pressors and other Agents:
-Norepinephrine (Levophed) 8-12 mcg/min IV, titrate to systolic 100 mmHg
(8 mg in 500 mL D5W) OR
-Dopamine (Intropin) 5-20 mcg/kg/min IV.
10. Extras: Portable CXR, ECG, allergy consult.
11. Labs: CBC, SMA 7&12.
