treatment algorithm for adults for medical first responders
Last reviewed 01/2018
An outline anaphylaxis treatment algorithm for adults for medical first responders is presented below (1):
- consider when anaphylaxis when compatible history of severe allergic-type reaction with respiratory difficulty and/or hypotension especially if skin changes present
- administer oxygen treatment when available
- assess for stridor, wheeze, respiratory distress or clinical signs of shock (a)
- administer
adrenaline (epinephrine) 1:1000 solution
- 0.5 mL (500 micrograms) IM (b,c)
- adrenaline dose is repeated in 5 minutes if no clinical improvement
- administer antihistamine (chlorphenamine) 10 mg IM/or slow IV
- additional considerations
- For all severe or recurrent reactions and patients with asthma give Hydrocortisone 200 mg IM/or slowly IV
- If clinical manifestations of shock do not
respond to drug treatment give 1-2 litres IV fluid (d)
- rapid infusion or one repeat dose may be necessary
Notes:
- (a) an inhaled beta2-agonist such as salbutamol may be used as an adjunctive measure if bronchospasm is severe and does not respond rapidly to other treatment
- (b) if profound shock judged immediately life threatening give CPR/ALS if necessary. Consider slow IV adrenaline (epinephrine) 1:10,000 solution. This is hazardous and is recommended only for an experienced practitioner who can also obtain IV access without delay. Note the different strength of adrenaline (epinephrine) that may be required for IV use
- (c) if adults are treated with an adrenaline auto-injector, the 300 micrograms will usually be sufficient. A second dose may be required. Half doses of adrenaline (epinephrine) may be safer for patients on amitriptyline, imipramine, or beta blocker
- (d) a crystalloid may be safer than a colloid.
Reference: