Pedi Anaphylaxis

[see Adult Anaphylaxis]

Background

Pathophysiology

History

Treatment

Prehospital care

  1. Stabilize ABC's
  2. Nasopharyngeal airway if needed
  3. High-flow O2
  4. IV access
  5. Epinephrine
  6. If cough, wheezing: Nebulized albuterol 2.25% Solution

Acute Treatment (Anaphylaxis Rx )

  1. ABCs, IV, O2, monitor, secure airway
  2. Fluids
  3. Epinephrine (ask if given in field)
  4. Vasopressors
  5. Antihistamines
  6. Bronchodilators
  7. H2 Blocker
  8. Steroids
  9. Glucagon 1-2mg IV over 1 min for resistant/ BBlkr use

Disposition

  1. Admit
  2. Observe 12-24 hrs
  3. Discharge

 

Admit Orders: Anaphylaxis

1. Admit to:
2. Diagnosis: Anaphylaxis
3. Condition:
4. Vital Signs: Call MD if:
5. Activity:
6. Nursing: Inputs and outputs, pulse oximeter.
7. Diet: Regular
8. IV Fluids: 2 IV lines. Normal saline or LR 10-20 mL/kg rapidly over 1h, then D5 1/2 NS at 1-1.5 times maintenance.
9. Special Medications:
  -O2 at 4 L/min by NC or mask.
  -Epinephrine, 0.01 mg/kg [0.01 mL/kg of 1 mg/mL = 1:1000] (maximum 0.5 mL) subcutaneously, repeat every 15-20 minutes prn. Usual dose for infants is 0.05-0.1mL, for children 0.1-0.3 mL, and for adolescents 0.3-0.5 mL. If anaphylaxis is caused by an insect sting or intramuscular injection, inject an additional 0.1 mL of epinephrine at the site to slow antigen absorption.
  -Epinephrine racemic (if stridor is present), 2.25% nebulized, 0.25-0.5 mL in 2.5 mL NS over 15 min q30 min-4h.
  -Albuterol (Ventolin [0.5%, 5 mg/mL soln]) nebulized 0.01-0.03 mL/kg (max 1 mL) in 2 mL NS q1-2h and prn; may be used in addition to epinephrine if necessary.
 Corticosteroids:
  -For severe symptoms, give hydrocortisone 5 mg/kg IV q8h until stable, then change to oral prednisone. If symptoms are mild, give prednisone: initially 2 mg/kg/day (max 40 mg) PO q12h, then taper the dose over 4-5 days.
 Antihistamines:
  -Diphenhydramine (Benadryl) 1 mg/kg/dose IV/IM/IO/PO q6h, max 50 mg/dose OR
  -Hydroxyzine (Vistaril) 0.5-1 mg/kg/dose IM/IV/PO q4-6h, max 50 mg/dose.
10. Extras and X-rays: Portable CXR.
11. Labs: CBC, SMA 7, ABG.