REMAC of N.Y.C. - A.L.S. Protocols

Regional Emergency Medical Advisory Committee of New York City
Prehospital Advanced Life Support Protocols
Copyright January 1996 (8/96)

510 ANAPHYLACTIC REACTION

MEDICAL CONTROL OPTIONS:

Begin Basic Life Support Anaphylactic Reaction procedures.
If the patient is exhibiting obvious airway compromise, perform Endotracheal Intubation, and administer Epinephrine 1.0 mg (10 ml of a 1:10,000 solution), via the Endotracheal Tube.
If Endotracheal Intubation has not been accomplished, administer Epinephrine 0.3 mg (0.3 ml of a 1:1,000 solution), subcutaneously.
Monitor vital signs every 5 minutes.
Begin Cardiac Monitoring, record and evaluate EKG strip.
Begin an IV infusion of Normal Saline (0.9 NS) or Ringer's Lactate (RL) via a large bore (14 - 16 gauge) catheter to keep vein open, or a Saline Lock.
If the patient has signs of shock, begin rapid IV/Saline Lock infusion of Normal Saline (0.9 NS) or Ringer's Lactate (RL), up to 3.0 liters.
Administer Diphenhydramine 50 mg, IV/Saline Lock bolus, or IM, if IV/Saline Lock access has not been established.
Contact Medical Control for implementation of one or more of the following MEDICAL CONTROL OPTIONS:

MEDICAL CONTROL OPTIONS:

OPTION A: Repeat any of the above Standing Orders.

OPTION B:
Administer Epinephrine 1.0 ug/min, IV/Saline Lock drip. Prepare infusion by adding 1.0 mg of Epinephrine (1.0 ml of a 1:1,000 solution) to 250 ml of Normal Saline (0.9 NS) (1 ug/min = 15 ml/hr = 15 gtts/min). If there is insufficient improvement in hemodynamic status, the infusion may be increased until the desired therapeutic effects are achieved or adverse affects appear. (Maximum dosage is 4 ug/min, IV/Saline Lock drip.)

OPTION C:
Administer Dopamine 5.0 ug/kg/min, IV/Saline Lock drip. If there is insufficient improvement in hemodynamic status, the infusion rate may be increased until desired therapeutic effects are achieved or adverse effects appear. (Maximum dosage is 20 ug/kg/min, IV/Saline Lock drip.)

OPTION D: Transportation decision.

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OPTION A:	Repeat any of the above Standing Orders.
OPTION B:	Administer Epinephrine 1.0 ug/min, IV/Saline Lock drip. Prepare infusion by adding 1.0 mg of Epinephrine (1.0 ml of a 1:1,000 solution) to 250 ml of Normal Saline (0.9 NS) (1 ug/min = 15 ml/hr = 15 gtts/min). If there is insufficient improvement in hemodynamic status, the infusion may be increased until the desired therapeutic effects are achieved or adverse affects appear. (Maximum dosage is 4 ug/min, IV/Saline Lock drip.)
OPTION C:	Administer Dopamine 5.0 ug/kg/min, IV/Saline Lock drip. If there is insufficient improvement in hemodynamic status, the infusion rate may be increased until desired therapeutic effects are achieved or adverse effects appear. (Maximum dosage is 20 ug/kg/min, IV/Saline Lock drip.)
OPTION D:	Transportation decision.